June 12, 2024
Please see below for a statement from Jeffrey S. Crowley, director of the Infectious Diseases Initiative at the O’Neill Institute for National and Global Health Law:
Last week, the Centers for Disease Control and Prevention (CDC) published CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. These guidelines represent an important step forward in promoting sexual health and offer a balanced, nuanced, and evidence-based approach to using doxycycline as a tool to reduce the impact of sexually transmitted infections (STIs) among the highly impacted populations of gay, bisexual and other men who have sex with men (MSM) and transgender women while taking seriously the responsibility to practice good stewardship of currently effective antimicrobial agents in the face of a global challenge of antimicrobial resistance.
The CDC estimates that one in five people in the United States had an STI on any given day in 2018, totaling nearly 68 million estimated infections, with MSM and transgender women being disproportionately impacted.
As a member of the National Academies of Sciences, Engineering, and Medicine (NASEM) committee that produced the consensus report, Sexually Transmitted Infections: Adopting a Sexual Health Paradigm, I applaud the CDC for taking important steps toward defining and embracing sexual health. Given the large health inequities present in our society, including among the LGBTQIA+ community, implementation of this guidance must be centered on taking an equity approach to ensure that Black, Latinx and other MSM and transgender women of color benefit from this new tool. To be most impactful, this must include funding organizations by and for Black and Latinx MSM and transgender people. Further, we must continue to support a robust research agenda to fill knowledge gaps and explore the effectiveness and balance of benefits and risks to recommending the use of doxycycline post-exposure prophylaxis for other populations, including cisgender women.
Jeffrey S. Crowley served as the director of the Office of National AIDS Policy and Senior Advisor on Disability Policy for President Barack Obama from 2009 – 2011, during which time he led the development of the first comprehensive National HIV/AIDS Strategy for the United States.