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PrEP and the Black Community

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HIV in US Communities of Color

Abstract

New HIV infections are disproportionately concentrated among black Americans. Yet the most powerful new tool to reduce HIV acquisition, daily oral antiretroviral preexposure prophylaxis (PrEP), is inequitably accessed. While black men and women comprised 43% of new diagnoses in 2017, and 44% of persons estimated to have risk behaviors that indicate a need for PrEP, only 14.9% of PrEP prescription in 2017 were to black persons. To address this serious inequity, higher levels of knowledge of HIV status, awareness and knowledge of PrEP, access to clinicians willing and trained to provide it, and support for adherent and persistence use will be required in the black community. This is an urgent priority as the nation moves forward with the “Ending the HIV Epidemic: A Plan for America” initiative that has a goal of reducing new HIV infections by 75% in the next 5 years and at least 90% by 2030 (Fauci et al. JAMA 321(9):844–845, 2019).

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References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Chamberland ME, Castro KG, Haverkos HW, Miller BI, Thomas PA, Reiss R, et al. Acquired immunodeficiency syndrome in the United States: an analysis of cases outside high-incidence groups. Ann Intern Med. 1984;101(5):617–23.

    Article  CAS  PubMed  Google Scholar 

  3. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, HIV Surveillance Report, 2017; 29. Retrieved 2 July 2019, from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf.

  4. US Preventive Services Task Force. Final recommendation statement: prevention of Human Immunodeficiency Virus (HIV) infection: preexposure prophylaxis. [Internet]. 2019. Retrieved 2 July 2019, from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis.

  5. Centers for Disease Control and Prevention. US Public Health Service: preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline2018. Retrieved 2 July 2019, from https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf.

  6. Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018;28(12):850–7.e9.

    Article  PubMed  Google Scholar 

  7. Nguyen C HT, Anderson J, Bush S, Dinh T, McCallister S, Mera R. Utilization of emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for HIV pre-exposure prophylaxis (PrEP) in the United States by age, gender and ethnicity (2014–2017). 10th IAS conference on HIV science (IAS 2019); Mexico City, 2019.

    Google Scholar 

  8. Centers for Disease Control and Prevention. Selected National HIV prevention and care outcomes. 2017. Retrieved 26 July 2019, from https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-prevention-and-care-outcomes.pdf.

  9. Song W, Mulatu MS, Rorie M, Zhang H, Gilford JW. HIV testing and positivity patterns of partners of HIV-diagnosed people in partner services programs, United States, 2013–2014. Public Health Rep. 2017;132(4):455–62.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pitasi MA, Delaney KP, Brooks JT, DiNenno EA, Johnson SD, Prejean J. HIV testing in 50 local jurisdictions accounting for the majority of new HIV diagnoses and seven states with disproportionate occurrence of HIV in rural areas, 2016–2017. MMWR Morb Mortal Wkly Rep. 2019;68(25):561–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liu Y, Silenzio VMB, Nash R, Luther P, Bauermeister J, Vermund S, et al. Suboptimal recent and regular HIV testing among black men who have sex with men in the United States: implications from a meta-analysis. J Acquir Immune Defic Syndr. 2019;81(2):125–33.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Eaton EF, Austin EL, Dodson CK, Heudebert JP, Muzny CA. Do young black men who have sex with men in the deep south prefer traditional over alternative STI testing? PLoS One. 2018;13(12):e0209666.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Trevethan R. Deconstructing and assessing knowledge and awareness in public health research. Front Public Health. 2017;5:194.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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: the motivational PrEP cascade. J Acquir Immune Defic Syndr. 2017;74(3):285.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li J, Berg CJ, Kramer MR, Haardörfer R, Zlotorzynska M, Sanchez TH. An integrated examination of county-and individual-level factors in relation to HIV pre-exposure prophylaxis awareness, willingness to use, and uptake among men who have sex with men in the US. AIDS Behav. 2019;23(7):1721–36.

    Google Scholar 

  16. Garnett M, Hirsch-Moverman Y, Franks J, Hayes-Larson E, El-Sadr WM, Mannheimer S. Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city. AIDS Care. 2018;30(1):9–17.

    Article  PubMed  Google Scholar 

  17. Zhang HL, Murthy B, Johnston B, Mortiboy M, Wu J, Samsa GP, et al. Public awareness of HIV pre-exposure prophylaxis in Durham, North Carolina: results of a community survey. N C Med J. 2019;80(1):7–11.

    PubMed  Google Scholar 

  18. Elopre L, McDavid C, Brown A, Shurbaji S, Mugavero MJ, Turan JM. Perceptions of HIV pre-exposure prophylaxis among young, black men who have sex with men. AIDS Patient Care STDs. 2018;32(12):511–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDs. 2015;29(2):102–10.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Centers for Disease Control and Prevention. National HIV behavioral surveys – reports. 2019. Retrieved 2 July 2019, from https://www.cdc.gov/hiv/statistics/systems/nhbs/reports.html.

  21. Sophus AI, Mitchell JW. A review of approaches used to increase awareness of pre-exposure prophylaxis (PrEP) in the United States. AIDS Behav. 2018:1–22.

    Google Scholar 

  22. Lockard A, Rosenberg ES, Sullivan PS, Kelley CF, Serota DP, Rolle C-PM, et al. Contrasting self-perceived need and guideline-based indication for HIV pre-exposure prophylaxis among young, black men who have sex with men offered pre-exposure prophylaxis in Atlanta, Georgia. AIDS Patient Care STDs. 2019;33(3):112–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Patel AS, Goparaju L, Sales JM, Mehta CC, Blackstock OJ, Seidman D, et al. Brief report: PrEP eligibility among at-risk women in the southern United States: associated factors, awareness, and acceptability. J Acquir Immune Defic Syndr. 2019;80(5):527–32.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sales JM, Sheth AN. Associations among perceived HIV risk, behavioral risk and interest in PrEP among black women in the southern US. AIDS Behav. 2019;23(7):1871–76.

    Google Scholar 

  25. Blackstock OJ, Frew P, Bota D, Vo-Green L, Parker K, Franks J, et al. Perceptions of community HIV/STI risk among US women living in areas with high poverty and HIV prevalence rates. J Health Care Poor Underserved. 2015;26(3):811.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Koren DE, Nichols JS, Simoncini GM. HIV pre-exposure prophylaxis and women: survey of the knowledge, attitudes, and beliefs in an urban obstetrics/gynecology clinic. AIDS Patient Care STDs. 2018;32(12):490–4.

    Article  PubMed  Google Scholar 

  27. Goparaju L, Experton LS, Praschan NC, Warren-Jeanpiere L, Young MA, Kassaye S. Women want pre-exposure prophylaxis but are advised against it by their HIV-positive counterparts. J AIDS Clin Res. 2015;6(11):1.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wingood GM, Dunkle K, Camp C, Patel S, Painter JE, Rubtsova A, et al. Racial differences and correlates of potential adoption of pre-exposure prophylaxis (PrEP): results of a national survey. J Acquir Immune Defic Syndr. 2013;63(0 1):S95.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Braksmajer A, Fedor TM, Chen S-R, Corales R, Holt S, Valenti W, et al. Willingness to take PrEP for HIV prevention: the combined effects of race/ethnicity and provider trust. AIDS Educ Prev. 2018;30(1):1–12.

    Article  PubMed  Google Scholar 

  30. Ojikutu BO, Bogart LM, Mayer KH, Stopka TJ, Sullivan PS, Ransome Y, et al. Spatial access and willingness to use pre-exposure prophylaxis among Black/African American individuals in the United States: cross-sectional survey. J Med Inf Res Public Health. 2019;5(1):e12405.

    Google Scholar 

  31. Garner W, Wilson BM, Beste L, Maier M, Ohl ME, Van Epps P. Gaps in preexposure prophylaxis uptake for HIV prevention in the Veterans Health Administration. Am J Public Health. 2018;108(S4):S305–S10.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access. AIDS Behav. 2014;18(2):226–40.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Calabrese SK, Earnshaw VA, Krakower DS, Underhill K, Vincent W, Magnus M, et al. A closer look at racism and heterosexism in medical students’ clinical decision-making related to HIV pre-exposure prophylaxis (PrEP): implications for PrEP education. AIDS Behav. 2018;22(4):1122–38.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Clement ME, Seidelman J, Wu J, Alexis K, McGee K, Okeke NL, et al. An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern US. AIDS Care. 2018;30(5):650–5.

    Article  PubMed  Google Scholar 

  35. Henny KD, Duke CC, Geter A, Gaul Z, Frazier C, Peterson J, et al. HIV-related training and correlates of knowledge, HIV screening and prescribing of nPEP and PrEP among primary care providers in Southeast United States. AIDS Behav. 2017;2019:1–10.

    Google Scholar 

  36. Smith DK, Chang M-H, Duffus WA, Okoye S, Weissman S. Missed opportunities to prescribe preexposure prophylaxis in South Carolina, 2013–2016. Clin Infect Dis. 2018;68(1):37–42.

    Article  Google Scholar 

  37. Mclaughlin S, Pitts R, Kapadia F, Greene R. Capturing missed opportunities for PrEP prescription in patient diagnosed with other STIs. ST I& HIV World Congress; Vancouver, Canada. Br Med J. 2019;95(Suppl 1):A202.

    Google Scholar 

  38. Seidman D, Carlson K, Weber S, Newmann S, Witt J. Family planning providers' knowledge of and attitudes toward preexposure prophylaxis for HIV prevention: a national survey. Contraception. 2015;92(4):411.

    Article  Google Scholar 

  39. Wood BR, Mann MS, Martinez-Paz N, Unruh KT, Annese M, Spach DH, et al. Project ECHO: telementoring to educate and support prescribing of HIV pre-exposure prophylaxis by community medical providers. Sex Health. 2018;15(6):601–5.

    Article  PubMed  Google Scholar 

  40. McGregor B, Belton A, Henry TL, Wrenn G, Holden KB. Improving behavioral health equity through cultural competence training of health care providers. Ethn Dis. 2019;29(Suppl 2):359–64.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Grant RM, Anderson PL, McMahan V, Liu A, Amico KR, Mehrotra M, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cottrell ML, Yang KH, Prince HM, Sykes C, White N, Malone S, et al. A translational pharmacology approach to predicting outcomes of preexposure prophylaxis against HIV in men and women using tenofovir disoproxil fumarate with or without emtricitabine. J Infect Dis. 2016;214(1):55–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Wheeler DP, Fields SD, Beauchamp G, Chen YQ, Emel LM, Hightow-Weidman L, et al. Pre-exposure prophylaxis initiation and adherence among black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study. J Int AIDS Soc. 2019;22(2):e25223.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Chartier M, Gylys-Cowell I, Van Epps P, Beste LA, Ohl M, Lowy E, et al. Accessibility and uptake of pre-exposure prophylaxis for HIV prevention in the veterans health administration. Fed Pract. 2018;35(Suppl 2):S42.

    PubMed  PubMed Central  Google Scholar 

  45. van Epps P, Maier M, Lund B, Howren MB, Beck B, Beste L, et al. Medication adherence in a nationwide cohort of veterans initiating pre-exposure prophylaxis (PrEP) to prevent HIV infection. J Acquir Immune Defic Syndr. 2018;77(3):272–8.

    Article  PubMed  Google Scholar 

  46. Chan PA, Mena L, Patel R, Oldenburg CE, Beauchamps L, Perez-Brumer AG, et al. Retention in care outcomes for HIV pre-exposure prophylaxis implementation programmes among men who have sex with men in three US cities. J Int AIDS Soc. 2016;19(1):20903.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Zucker J, Carnevale C, Richards P, Slowikowski J, Borsa A, Gottlieb F, et al. Predictors of disengagement in care for individuals receiving pre-exposure prophylaxis (PrEP). JAIDS J Acquired Immune Defic Syndr. 2019;81(4):e104–e8.

    Article  Google Scholar 

  48. Arrington-Sanders R, Wilson CM, Perumean-Chaney SE, Patki A, Hosek S. Brief report: role of sociobehavioral factors in subprotective TFV-DP levels among YMSM enrolled in 2 PrEP trials. J Acquired Immune Defic Syndr. 2019;80(2):160–5.

    Article  Google Scholar 

  49. Hosek S, Rudy B, Landovitz R, Kapogiannis B, Siberry G, Rutledge B, et al. An HIV pre-exposure prophylaxis (PrEP) demonstration project and safety study for young MSM. J Acquir Immune Defic Syndr. 2017;74(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Bazzi AR, Drainoni M-L, Biancarelli DL, Hartman JJ, Mimiaga MJ, Mayer KH, et al. Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions. BMC Public Health. 2019;19(1):31.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Molina J-M, Charreau I, Spire B, Cotte L, Chas J, Capitant C, et al. Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017;4(9):e402–e10.

    Article  PubMed  Google Scholar 

  52. Saag MS, Benson CA, Gandhi RT, Hoy JF, Landovitz RJ, Mugavero MJ, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2018 recommendations of the International Antiviral Society–USA Panel. JAMA. 2018;320(4):379–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Anderson PL, García-Lerma JG, Heneine W. Non-daily pre-exposure prophylaxis for HIV prevention. Curr Opin HIV AIDS. 2016;11(1):94.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Grant RM, Mannheimer S, Hughes JP, Hirsch-Moverman Y, Loquere A, Chitwarakorn A, et al. Daily and nondaily oral preexposure prophylaxis in men and transgender women who have sex with men: the Human Immunodeficiency Virus Prevention Trials Network 067/ADAPT Study. Clin Infect Dis. 2018;66(11):1712–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Velloza J, Bacchetti P, Hendrix CW, Murnane P, Hughes JP, Li M, et al. Short and long-term pharmacologic measures of HIV pre-exposure prophylaxis use among high-risk men who have sex with men in HPTN 067/ADAPT. J Acquir Immune Defic Syndr. 2019;82(2):149–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Mannheimer S, Hirsch-Moverman Y, Franks J, Loquere A, Hughes JP, Li M, et al. Factors associated with sex-related pre-exposure prophylaxis adherence among men who have sex with men in New York City in HPTN 067. J Acquir Immune Defic Syndr. 2019;80(5):551.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238–43.

    Article  PubMed  PubMed Central  Google Scholar 

  58. National Center for Health Statistics. Leading Causes of Death (LCOD) by age group, black females-United States, 2015. 2018. Retrieved 22 July 2019, from https://www.cdc.gov/women/lcod/2015/black/index.htm.

  59. National Center for Health Statistics. Leading Causes of Death (LCOD) by Age Group, Black Males-United States, 2015. 2018. Retrieved 22 July 2019, from https://www.cdc.gov/healthequity/lcod/men/2015/black/index.htm.

  60. Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV. 2018;5(11):e629–e37.

    Article  PubMed  Google Scholar 

  61. Jenness SM, Maloney KM, Smith DK, Hoover KW, Goodreau SM, Rosenberg ES, et al. Addressing gaps in HIV preexposure prophylaxis care to reduce racial disparities in HIV incidence in the United States. Am J Epidemiol. 2018;188(4):743–52.

    Article  PubMed Central  Google Scholar 

  62. Departnment of Health and Human Services. What is ‘ending the HIV epidemic: a plan for America’?. 2019. Retrieved 22 July 2019, from https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview.

  63. Department of Health and Human Services. Flyer: ending the HIV epidemic: a plan for America. 2019. Retrieved 22 July 2019, from https://files.hiv.gov/s3fs-public/ending-the-hiv-epidemic-flyer.pdf.

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Smith, D.K., Rawlings, M.K. (2021). PrEP and the Black Community. In: Ojikutu, B., Stone, V. (eds) HIV in US Communities of Color. Springer, Cham. https://doi.org/10.1007/978-3-030-48744-7_3

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