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International Journal of Behavioral Medicine

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01-12-2021 | Human Immunodeficiency Virus | Full length manuscript

Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men

Authors: Calvin Fitch, Jacklyn Foley, Monina Klevens, Jesse Najarro Cermeño, Abigail Batchelder, Kenneth Mayer, Conall O’Cleirigh

Published in: International Journal of Behavioral Medicine | Issue 6/2021

Abstract

Background

Limited access to healthcare has been associated with limited uptake of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM). This descriptive analysis examined, in a near universal healthcare setting, differences between MSM reporting using versus not using PrEP in the past 12 months.

Method

Data come from the 2017 Boston sample of the National HIV Behavioral Surveillance (NHBS) system, containing a venue-based and time-spaced sample of 530 MSM. The analysis used descriptive frequencies and tests of bivariate associations by PrEP use using Fisher’s exact test.

Results

Five hundred four respondents had data necessary to determine if PrEP was indicated, and 233 (43.9%) had an indication for PrEP. Of these 233 participants, 117 (50.2%) reported using PrEP in the past 12 months. Not being out, in terms of disclosing one’s sexual orientation to a healthcare provider, lack of health insurance, limited access to healthcare, and history of incarceration were all significantly associated with not using PrEP in the past 12 months. Race/ethnicity was not significantly associated with PrEP use in the past 12 months.

Conclusions

In the setting of Massachusetts healthcare expansion and reform, and in a sample somewhat uncharacteristic of the population of individuals experiencing difficulties accessing PrEP, structural and demographic factors remain potent barriers to PrEP uptake. Targeted PrEP expansion efforts in Massachusetts may focus on identifying vulnerable subgroups of MSM (e.g., underinsured or criminal justice system-involved MSM) and delivering evidence-based interventions to reduce stigma and promote disclosure of same-sex behavior in healthcare settings.

Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (Updated). https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-31.pdf. Published May 2020. Accessed August 1, 2020.

Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99. https://doi.org/10.1056/NEJMoa1011205.CrossRefPubMedPubMedCentral

Mayer KH, Skeer M, Mimiaga MJ. Biomedical approaches to HIV prevention. Alcohol Res Health. 2010;33(3):195–202.PubMedPubMedCentral

Mayer KH, Molina JM, Thompson MA, Anderson PL, Mounzer KC, De Wet JJ, Hare CB. Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial. The Lancet. 2020;396(10246):239–54.CrossRef

McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet. 2016;387(10013):53–60. https://doi.org/10.1016/S0140-6736(15)00056-2.CrossRefPubMedPubMedCentral

Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46. https://doi.org/10.1056/NEJMoa1506273.CrossRefPubMed

Mayer KH, Safren SA, Elsesser SA, et al. Optimizing pre-exposure antiretroviral prophylaxis adherence in men who have sex with men: Results of a pilot randomized controlled trial of “Life-Steps for PrEP.” AIDS Behav. 2017;21(5):1350–60. https://doi.org/10.1007/s10461-016-1606-4.CrossRefPubMedPubMedCentral

Sullivan PS, Giler RM, Mouhanna F, et al. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Ann Epidemiol. 2018;28(12):833–40. https://doi.org/10.1016/j.annepidem.2018.06.009.CrossRefPubMedPubMedCentral

Sullivan PS, Sanchez TH, Zlotorzynska M, et al. National trends in HIV pre-exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017. J Int AIDS Soc. 2020;23(3):e25461. https://doi.org/10.1002/jia2.25461.CrossRefPubMedPubMedCentral

10.

Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS. 2017;31(5):731–4. https://doi.org/10.1097/QAD.0000000000001385.CrossRefPubMed

11.

Parsons JT, Rendina HJ, Lassiter JM, Whitfield TH, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States. J Acquir Immune Defic Syndr. 2017;74(3):285–92. https://doi.org/10.1097/QAI.0000000000001251.CrossRefPubMedPubMedCentral

12.

Smith DK, Van Handel M, Wolitski RJ, et al. Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition--United States, 2015. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w. Published November 2015. Accessed August 1, 2020.

13.

Grov C, Jonathan Rendina H, Patel VV, Kelvin E, Anastos K, Parsons JT. Prevalence of and factors associated with the use of HIV serosorting and other biomedical prevention strategies among men who have sex with men in a US nationwide survey. AIDS Behav. 2018;22(8):2743–55. https://doi.org/10.1007/s10461-018-2084-7.CrossRefPubMedPubMedCentral

14.

Jenness SM, Goodreau SM, Rosenberg E, et al. Impact of the Centers for Disease Control’s HIV preexposure prophylaxis guidelines for men who have sex with men in the United States. J Infect Dis. 2016;214(12):1800–7. https://doi.org/10.1093/infdis/jiw223.CrossRefPubMedPubMedCentral

15.

Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13:482. https://doi.org/10.1186/1471-2458-13-482.CrossRefPubMedPubMedCentral

16.

Krakower DS, Mimiaga MJ, Rosenberger JG, et al. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an Internet social networking site. PLoS ONE. 2012;7(3):e33119. https://doi.org/10.1371/journal.pone.0033119.CrossRefPubMedPubMedCentral

17.

Brooks RA, Kaplan RL, Lieber E, Landovitz RJ, Lee SJ, Leibowitz AA. Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care. 2011;23(9):1136–45. https://doi.org/10.1080/09540121.2011.554528.CrossRefPubMedPubMedCentral

18.

Hannaford A, Lipshie-Williams M, Starrels JL, et al. The use of online posts to identify barriers to and facilitators of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: A comparison to a systematic review of the peer-reviewed literature. AIDS Behav. 2018;22(4):1080–95. https://doi.org/10.1007/s10461-017-2011-3.CrossRefPubMedPubMedCentral

19.

Liu A, Cohen S, Follansbee S, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Med. 2014;11(3):e1001613. https://doi.org/10.1371/journal.pmed.1001613.CrossRefPubMedPubMedCentral

20.

Peng P, Su S, Fairley CK, et al. A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: A systematic review and meta-analysis. AIDS Behav. 2018;22(4):1063–74. https://doi.org/10.1007/s10461-017-1675-z.CrossRefPubMed

21.

Pérez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: The P18 Study. AIDS Educ Prev. 2015;27(2):112–25. https://doi.org/10.1521/aeap.2015.27.2.112.CrossRefPubMedPubMedCentral

22.

Wao H, Aluoch M, Odondi GO, Tenge E, Iznaga T. MSM’s versus health care providers’ perceptions of barriers to uptake of HIV/AIDS-related interventions: Systematic review and meta-synthesis of qualitative and quantitative evidence. Int J Sex Health. 2016;28(2):151–62. https://doi.org/10.1080/19317611.2016.1153560.CrossRef

23.

Brewer RA, Magnus M, Kuo I, Wang L, Liu TY, Mayer KH. The high prevalence of incarceration history among Black men who have sex with men in the United States: Associations and implications. Am J Public Health. 2014;104(3):448–54. https://doi.org/10.2105/AJPH.2013.301786.CrossRefPubMedPubMedCentral

24.

Zaller ND, Neher TL, Presley M, et al. Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis. PLoS One. 2020;15(4):e0231951. Published 2020 Apr 17. doi:https://doi.org/10.1371/journal.pone.0231951

25.

Sullivan PS, Siegler AJ. Getting pre-exposure prophylaxis (PrEP) to the people: opportunities, challenges and emerging models of PrEP implementation. Sex Health. 2018;15(6):522–7. https://doi.org/10.1071/SH18103.CrossRefPubMedPubMedCentral

26.

Massachusetts Department of Public Health. Massachusetts Integrated HIV/AIDS Prevention and Care Plan. https://www.mass.gov/files/documents/2016/12/vz/mass-hiv-aids-plan.pdf. Published December 2016. Accessed August 1, 2020.

27.

Massachusetts Department of Public Health. HIV/AIDS Service and Resource Guide. https://www.mass.gov/files/documents/2018/01/09/resources-guide.pdf. Published January 2018. Accessed August 1, 2020.

28.

Kaiser Family Foundation. Election 2020: State Health Care Snapshots. https://www.kff.org/statedata/election-state-fact-sheets/. Published February 2020. Accessed August 1, 2020.

29.

Chin M, Gurewich D, Muhr K, Posner H, Rosinski J, LaFlamme E. The Remaining Uninsured in Massachusetts: Experiences of Individuals Living without Health Insurance Coverage. https://www.bluecrossmafoundation.org/sites/default/files/download/publication/Remaining_Uninsured_Final.pdf. Published February 2016. Accessed 1 Aug 2020.

30.

Centers for Disease Control and Prevention. National HIV Behavioral Surveillance (NHBS). https://www.cdc.gov/hiv/statistics/systems/nhbs/index.html. Updated May 2020. Accessed August 1, 2020.

31.

US Department of Health and Human Services. US federal poverty guidelines used to determine financial eligibility for certain federal programs. https://aspe.hhs.gov/2017-poverty-guidelines. Published January 2017. Accessed August 1, 2020.

32.

Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–76. https://doi.org/10.1017/s0033291702006074.CrossRefPubMed

33.

Finlayson T, Cha S, Xia M, et al. Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men - 20 urban areas, 2014 and 2017. MMWR Morb Mortal Wkly Rep. 2019;68(27):597–603. https://doi.org/10.15585/mmwr.mm6827a1.CrossRefPubMedPubMedCentral

34.

Klevens RM, Martin BM, Doherty R, Fukuda HD, Cranston K, DeMaria A Jr. Factors associated with pre-exposure prophylaxis in a highly insured population of urban men who have sex with men, 2014. AIDS Behav. 2018;22(4):1201–8. https://doi.org/10.1007/s10461-017-1879-2.CrossRefPubMed

35.

Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: A plan for the United States. JAMA. 2019;321(9):844–5. https://doi.org/10.1001/jama.2019.1343.CrossRefPubMed

36.

Doblecki-Lewis S, Liu A, Feaster D, et al. Healthcare access and PrEP continuation in San Francisco and Miami following the US PrEP demo project. J Acquir Immune Defic Syndr. 2017;74(5):531.CrossRefPubMedPubMedCentral

37.

Patel RR, Mena L, Nunn A, et al. Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention. PLoS ONE. 2017;12(5):e0178737. https://doi.org/10.1371/journal.pone.0178737.CrossRefPubMedPubMedCentral

38.

Brinkley-Rubinstein L, Peterson M, Arnold T, et al. Knowledge, interest, and anticipated barriers of pre-exposure prophylaxis uptake and adherence among gay, bisexual, and men who have sex with men who are incarcerated. PLoS One. 2018;13(12):e0205593. https://doi.org/10.1371/journal.pone.0205593.CrossRefPubMedPubMedCentral

39.

Meyer IH, Flores AR, Stemple L, Romero AP, Wilson BD, Herman JL. Incarceration rates and traits of sexual minorities in the United States: National Inmate Survey, 2011–2012. Am J Public Health. 2017;107(2):267–73.CrossRefPubMedPubMedCentral

40.

Brinkley-Rubinstein L, Peterson M, Zaller ND, Wohl DA. Best practices for identifying men who have sex with men for corrections-based pre-exposure prophylaxis provision. Health & justice. 2019;7(1):1–4.CrossRef

41.

Metcalfe R, Laird G, Nandwani R. Don't ask, sometimes tell. A survey of men who have sex with men sexual orientation disclosure in general practice. Int J STD AIDS. 2015;26(14):1028–1034. https://doi.org/10.1177/0956462414565404

42.

Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, et al. State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS. 2015;29(7):837–45. https://doi.org/10.1097/QAD.0000000000000622.CrossRefPubMed

43.

Santos GM, Beck J, Wilson PA, et al. Homophobia as a barrier to HIV prevention service access for young men who have sex with men. J Acquir Immune Defic Syndr. 2013;63(5):e167–70. https://doi.org/10.1097/QAI.0b013e318294de80.CrossRefPubMed

44.

Maloney KM, Krakower DS, Ziobro D, Rosenberger JG, Novak D, Mayer KH. Culturally competent sexual healthcare as a prerequisite for obtaining preexposure prophylaxis: Findings from a qualitative study. LGBT Health. 2017;4(4):310–4. https://doi.org/10.1089/lgbt.2016.0068.CrossRefPubMedPubMedCentral

45.

Rowan D, DeSousa M, Randall EM, White C, Holley L. We’re just targeted as the flock that has HIV”: Health care experiences of members of the house/ball culture. Soc Work Health Care. 2014;53(5):460–77. https://doi.org/10.1080/00981389.2014.896847.CrossRefPubMed

46.

Irvin R, Wilton L, Scott H, et al. A study of perceived racial discrimination in Black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing. AIDS Behav. 2014;18(7):1272–8. https://doi.org/10.1007/s10461-014-0734-y.CrossRefPubMedPubMedCentral

47.

Beyrer PC, Sullivan PS, Sanchez J, et al. A call to action for comprehensive HIV services for men who have sex with men. Lancet. 2012;380(9839):424–38. https://doi.org/10.1016/S0140-6736(12)61022-8.CrossRefPubMedPubMedCentral

Title: Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men
Authors: Calvin Fitch
Jacklyn Foley
Monina Klevens
Jesse Najarro Cermeño
Abigail Batchelder
Kenneth Mayer
Conall O’Cleirigh
Publication date: 01-12-2021
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: International Journal of Behavioral Medicine / Issue 6/2021
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-021-09986-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

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