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Factors Associated with the Awareness of and Willingness to Use HIV Pre-exposure Prophylaxis Among Gay, Bisexual, and Other Men Who Have Sex with Men, Baltimore, MD, 2017–2019

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Abstract

Pre-exposure prophylaxis (PrEP) is an effective tool in protecting persons from acquiring HIV infection through sex or injection drug use. However, awareness and willingness to use PrEP among Black gay, bisexual, and other men who have sex with men (BMSM) remain suboptimal compared to White MSM (WMSM) in the United States. Our aims were to (1) assess the factors associated with PrEP awareness and willingness to use PrEP among MSM and (2) compare the PrEP perceptions among BMSM versus non-Black MSM. Data were drawn from two cross-sectional behavioral surveys in Baltimore, MD: Behavioral Surveillance Research (BESURE) conducted in 2017, and Safe Spaces 4 Sexual Health (SS4SH), conducted in 2018 and 2019. Descriptive statistics were used to summarize the study population. We used Poisson regression models to identify variables associated with awareness of PrEP and willingness to use PrEP. PrEP perceptions were assessed via 13 items scored on a 5-point Likert scale. Finally, we conducted a post-hoc exploratory bivariate analysis of the relationship between PrEP perception and willingness to use PrEP, stratified by race/ethnicity. A total of 261 MSM participated in this study. Many of the participants were aware of PrEP (75.1%). Factors associated with greater PrEP awareness included having greater than a high school education (aRR 1.22, 95% CI 1.04, 1.43); and earning more than $25,000 annually (aRR 1.24, 95% CI 1.08, 1.42). Participants who had received money in exchange for sex one or more times were less likely to be aware of PrEP (aRR 0.59, 95% CI 0.36, 0.95). More than half of the participants were willing to use PrEP (55.3%). In bivariate and multivariable analyses, demographic or behavioral characteristics were not significantly associated with willingness to use PrEP. Higher agreement with the following statements was associated with lower willingness to use PrEP: “Having to take a pill every day is difficult” (RR 0.89, 95% CI 0.82–0.97) and, “I am concerned about the side effects of PrEP” (RR 0.89, 95% CI 0.82–0.96), and “PrEP is for people who have riskier sex lives than I do” (RR 0.86, 95% CI 0.78–0.95). Conversely, higher willingness to use PrEP was associated with comfortable having sex without a condom (RR 1.11, 95% CI 1.02–1.21), less anxious about sex (RR 1.12, 95% CI 1.02–1.24), and my friends think that I should take PrEP (RR 1.19, 95% CI 1.07–1.32). We found BMSM compared to non-Black MSM had higher mean scores related to taking a daily pill (p = 0.041), concerns about side effects (p = 0.012), concerns about people thinking they had HIV (p = 0.001), concerns about the financial costs of PrEP (p = 0.038) and caution when dealing with healthcare organizations/medical mistrust (p = 0.019). Perceptions with a statistically significant lower score among BMSM versus non-Black MSM included statements such as, comfortable having sex without a condom (p = 0.003) and less anxious about sex (p < 0.001). We conclude HIV prevention strategies, programs, and interventions should be cognizant of PrEP perceptions that facilitate or hinder PrEP uptake in Baltimore City, MD.

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Funding

This work was supported, in part, by the Centers for Disease Control and Prevention of the US Department of Health and Human Services (HHS) award U01PS005115.

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Authors and Affiliations

  1. Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, USA

    Hope King & Kimberly N. Evans

  2. Johns Hopkins School of Medicine, Baltimore, USA

    Nicole Thornton, Jacky Jennings & Errol L. Fields

  3. Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Yomi Tadfor & Danielle German

  4. Maryland Department of Health, Baltimore, USA

    Colin Flynn

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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Nicole Thornton, Kimberly Evans, and Errol Fields. The first draft of the manuscript was written by Hope King, and all authors, Yomi Tadfor, Danielle German, Colin Flynn, and Jacky Jennings, commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hope King.

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The SS4SH and BESURE studies were reviewed and approved by the Institutional Review Board at the Johns Hopkins School of Medicine and the Johns Hopkins School of Public Health and the Maryland Department of Health, respectively.

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Dr. Errol Fields has served on an advisory board for Gilead Sciences and Roche Diagnostics. All other authors have no relevant financial or non-financial interests to disclose.

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King, H., Thornton, N., Evans, K.N. et al. Factors Associated with the Awareness of and Willingness to Use HIV Pre-exposure Prophylaxis Among Gay, Bisexual, and Other Men Who Have Sex with Men, Baltimore, MD, 2017–2019. J. Racial and Ethnic Health Disparities (2024). https://doi.org/10.1007/s40615-024-01954-w

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