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Factors Associated with PrEP Support and Disclosure Among YMSM and Transgender Individuals Assigned Male at Birth in Chicago

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Abstract

Pre-exposure prophylaxis (PrEP) is one of the best biomedical HIV prevention tools available. However, uptake, particularly in communities of men who have sex with men (MSM) and transgender individuals assigned male at birth (AMAB), remains low. Further, the role of an individual’s social support structure on PrEP uptake and adherence remains largely understudied. Understanding MSM and AMAB transgender individuals’ perceptions of PrEP use as well as support and patterns of disclosure of (or intent to disclose) their PrEP status may offer key insights into how best to improve uptake in vulnerable communities. Further, the influence of one’s social connections on other factors, such as perceptions of and conversations about PrEP deserves attention as well, as these factors may be key to improved knowledge and uptake. Therefore, we assessed perceptions of PrEP use, disclosure of or intent to disclose PrEP status, and social support and associated factors among a cohort of MSM and AMAB transgender individuals in a large Midwestern city. Results demonstrated that, among those not taking PrEP, bisexual participants and those unsure of their sexual identity were less likely to be comfortable with the idea of disclosing PrEP use were they ever to start taking it. Encouragingly however, we found that individuals who reported disclosing their PrEP status had high rates of support among friends and relatives. We also observed that knowing someone else who was on PrEP was associated with increased likelihood of discussing PrEP with one’s medical provider, as was increased age. Other findings and implications for research, policy, and practice are discussed within.

Resumen

La profilaxis de prexposición (PrEP) es una de las mejores herramientas biomédicas disponibles para la prevención del VIH. Sin embargo, el uso, particularmente en las comunidades de hombres que tienen sexo con hombres (HSH) y las personas transgéneros asignadas a un hombre al nacer (AHAN), sigue siendo baja. Además, el papel de la estructura de apoyo social de un individuo en el uso y adherencia de PrEP sigue siendo poco estudiado. Comprender las percepciones de HSH y las personas transgéneros AHAN sobre el uso de PrEP, así como el apoyo y los patrones de divulgación (o la intención de revelar) su estado de PrEP puede ofrecer información clave sobre la mejor manera de mejorar el uso en las comunidades vulnerables. Además, la influencia de las conexiones sociales de una persona en otros factores, como las percepciones y conversaciones sobre la PrEP, también merece atención, en que estos factores pueden ser clave para mejorar el conocimiento y el uso. Por lo tanto, evaluamos las percepciones del uso de PrEP, la divulgación o la intención de revelar el estado de PrEP, y el apoyo social y los factores asociados entre una cohorte de HSH y personas transgéneros en una gran ciudad del Medio Oeste. Los resultados demostraron que, entre los que no tomaban PrEP, los participantes bisexuales y los que no estaban seguros de su identidad sexual tenían menos probabilidades de sentirse cómodos con la idea de revelar el uso de PrEP si alguna vez comenzaban a tomarla. Sin embargo, de manera alentadora, encontramos que las personas que informaron haber revelado su estado de PrEP tenían altas tasas de apoyo entre amigos y familiares. También observamos que conocer a otra persona que estaba tomando la PrEP se asoció con una mayor probabilidad de discutir la PrEP con el proveedor médico, al igual que el aumento de la edad. Otros hallazgos e implicaciones para la investigación, la política, y la práctica se discuten dentro.

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Acknowledgements

The authors wish to acknowledge and thank Antonia Clifford, Dan Ryan, and the participants of the RADAR study. Additionally, the authors wish to acknowledge the following source of funding: U01DA036939, PI: Mustanski.

Funding

This study was funded by a grant from the National Institute on Drug Abuse (NIDA): U01DA036939, PI: Mustanski.

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Authors and Affiliations

  1. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave 14-043, Chicago, IL, 60611, USA

    Gregory Phillips II, Anand Raman, Dylan Felt, Ying Han & Brian Mustanski

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  1. Gregory Phillips II
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  2. Anand Raman
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Correspondence to Gregory Phillips II.

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Phillips, G., Raman, A., Felt, D. et al. Factors Associated with PrEP Support and Disclosure Among YMSM and Transgender Individuals Assigned Male at Birth in Chicago. AIDS Behav 23, 2749–2760 (2019). https://doi.org/10.1007/s10461-019-02561-1

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