Advertisement

AIDS and Behavior

, Volume 20, Issue 7, pp 1443–1450 | Cite as

Attitudes Toward HIV Pre-Exposure Prophylaxis in a United States Urban Clinic Population

  • Helena A. KwakwaEmail author
  • Sophia Bessias
  • Donielle Sturgis
  • Natasha Mvula
  • Rahab Wahome
  • Catelyn Coyle
  • Timothy P. Flanigan
Original Paper

Abstract

A majority of US studies on attitudes toward PrEP focus on men who have sex with men with little representation of African Americans. This cross-sectional study seeks to determine openness to PrEP, and examine motivations for openness among Philadelphia residents. Patients undergoing HIV rapid testing between May 2012 and December 2014 in a public setting were administered a survey. Questions included openness to PrEP and reasons for openness to PrEP. Multivariate logistic regression models were used to investigate associations between openness and potential predictors. Analyses were conducted using R version 3.2.4 and the epitools and car packages. Of 5606 respondents, over 90 % were African American. Men were more likely to express openness (61.4 % of men, 54.8 % of women, p < 0.0001). Predictors of openness were younger age, black race, higher perceived risk for HIV by patient or as assessed by Tester, intermittent /no condom use, greater number of partners in 12 months and previous HIV testing. The main reason for openness was fear of HIV, and for disinterest was lack of recognition of risk. Understanding openness to PrEP, and reasons for openness to or disinterest in PrEP are critical to determining the best approaches to facilitate engagement in PrEP care by communities and persons at elevated risk for HIV acquisition. Further study is needed on how best to manage disinterest in PrEP by those at high risk for HIV, and how openness to PrEP translates into concrete steps to take PrEP.

Keywords

PrEP HIV Urban Attitudes US 

Notes

Acknowledgments

The authors wish to acknowledge Dawn K. Smith MD, MS, MPH of the Centers for Disease Control and Prevention, and M. Keith Rawlings MD of Gilead Sciences for their invaluable review of and advice in the development of this manuscript.

Funding

No funding was received for this study.

References

  1. 1.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomized, double-blind, placebo-controlled phase 3 trial. The Lancet. 2013;381(9883):2083–90.CrossRefGoogle Scholar
  3. 3.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367:399–410.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, TDF2 Study Group, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34.CrossRefPubMedGoogle Scholar
  5. 5.
    Murnane PM, Celum C, Mugo N, Campbell JD, Donnell D, Bukusi E, et al. Efficacy of pre-exposure prophylaxis for HIV-1 prevention among high risk heterosexuals: subgroup analyses from a randomized trial. AIDS. 2013;27(13):2155–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Donnell D, Baeten JM, Bumpus NN, Brantley J, Bangsberg DR, Haberer JE, et al. HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. J Acquir Immune Defic Syndr. 2014;66(3):340–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Food and Drug Administration. Truvada approved to reduce the risk of sexually transmitted HIV in people who are not infected with the virus. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2012. http://www.fda.gov/forconsumers/byaudience/forpatientadvocates/hivandaidsactivities/ucm312264.htm.
  8. 8.
    Rawlings K, Mera R, Pechonkina A, Rooney JF, Peschel T, Cheng A, et al. Status of Truvada (TVD) for HIV pre-esposure prophylaxis in the United States: an early drug utilization analysis. 53rd interscience conference on antimicrobial agents and chemotherapy (ICAAC 2013). Denver, Colorado, September 10–13, 2013.Google Scholar
  9. 9.
    Flash C, Landovitz R, Giler RM, Ng L, Magnuson D, Bush S, et al. Two years of Truvada for preexposure prophylaxis utilization in the US. J Int AIDS Soc 2014;17(Suppl 3):19730.Google Scholar
  10. 10.
    Bush S, Ng L, Magnuson D, et al. Significant uptake of Truvada for pre-exposure prophylaxis (PrEP) utilization in the US in late 2014-1Q2015. 10th international conference on HIV treatment and prevention adherence 2015; Miami, Florida, June 28–30, 2015.Google Scholar
  11. 11.
    Centers for Disease Control and Prevention. HIV Surveillance Report: Diagnosis of HIV Infection and AIDS in the United States and Dependent Areas, 2013: Vol. 25.Google Scholar
  12. 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. MMWR Morb Mortal Wkly Rep. 2015;64(46):1291–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Eisingerich AB, Wheelock A, Gomez GB, Gernett GP, Dybul R, Piot PK. Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study. PLoS ONE. 2012;7(1):e28238.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Toledo L, McLellan-Lemal E, Henderson FL, Kebaabetswe PM. Knowledge, attitudes, and experiences of HIV pre-exposure prophylaxis (PrEP) trial participants in Botswana. World J AIDS. 2015;5(01):10.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Koester K, Amico KR, Liu A, Mcmahon V, Hosek S, Mayer K, et al. Sex on PrEP:qualitative findings from the iPrex Open Lable Extension (iPrex OLE) in the United States. Twentieth international AIDS conference. Melbourne, Australia, July 20–25, 2014. Abstract TUAC0102.Google Scholar
  16. 16.
    Grant RM, 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.CrossRefPubMedGoogle Scholar
  17. 17.
    Lorente N, Fugin L, Carrieri MP, Andreo C, Le Gall JM, Cook E, et al. Acceptability of “on-demand” pre-exposure HIV prophylaxis trial among men who have sex with men living in France. AIDS Care. 2012;24(4):468–77.PubMedGoogle Scholar
  18. 18.
    Barash EA, Golden M. Awareness and use of HIV pre-exposure prophylaxis among attendees of a Seattle gay pride event and sexually transmitted disease clinic. AIDS Patient Care STDs. 2010;24(11):689–91.CrossRefPubMedGoogle Scholar
  19. 19.
    Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Pre-exposure antiretroviral prophylaxis (PrEP) attitudes in high risk Boston area MSM: limited knowledge and experience, but potential for increased utilization after education. J Acquir Immune Defic Syndr. 2009;50(1):77.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Krakower DS, Mimiaga MJ, Rosenberger JG, Novak DS, Mitty JA, White JM, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Wienberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDs. 2013;27(4):248–54.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cohen SE, Vittinghoff E, Bacon O, Doblecki-Lewis S, Postle BS, Feaster DJ. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: baseline data from the US PrEP demonstration project. J Acquir Immune Defic Syndr. 2015;68(4):439–48.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Gamarel KE, Golub SA. Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Ann Behav Med. 2015;49:177–86.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hoff CC, Chakravarty D, Bircher AE, Campbell CK, Grisham K, Neilands TB, et al. Attitudes towards PrEP and anticipated condom use among concordant HIV-negative and HIV-discordant male couples. AIDS Patient Care STDs. 2015;29(7):408–17.CrossRefPubMedGoogle Scholar
  26. 26.
    Smith DK, Toledo L, Smith DJ, Adams MA, Rothenberg R. Attitudes and program preferences of African American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Educ Prev. 2012;24(5):408–21.CrossRefPubMedGoogle Scholar
  27. 27.
    Whiteside YO, Harris T, Scanlon C, Clarkson S, Duffus W. Self-perceived risk of HIV infection and attitudes about preexposure prophylaxis among sexually transmitted disease clinic attendees in South Carolina. AIDS Patient Care STDs. 2011;25(6):365–70.CrossRefPubMedGoogle Scholar
  28. 28.
    Aragon TJ. Epitools: Epidemiology Tools. R package version 0.5-7 2012. https://CRAN.R-project.org/package=epitools.
  29. 29.
    Fox J, Weisberg S. An R companion to applied Regression, Second Edition. Thousand Oaks: Sage. http://socserv.socsci.mcmaster.ca/jfox/Books/Companion.
  30. 30.
    Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV? A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18(2):195–216.CrossRefPubMedGoogle Scholar
  31. 31.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Flash CA, Stone VE, Mitty JA, Mimiaga MJ, Hall KT, Krakower D, et al. Perspectives on HIV prevention among urban black women: a potential role for HIV pre-exposure prophylaxis. AIDS Patient Care STDs. 2014;28(12):635–42.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    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(01):S95–101.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Media_Justice. History of media messages on HIV and AIDS. 2009. http://amplifyyourvoice.org/u/media_justice/2009/12/03/history-of-media-messages-on-hiv-aids/.
  35. 35.
    Noar SM, Kennedy MG. HIV/AIDS prevention messages. Virtual Mentor. 2009;11(12):980–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Denning P, DiNenno E. Communities in crisis: is there a generalized HIV epidemic in impoverished urban areas of the United States. XVIII international AIDS conference 2010. Vienna.Google Scholar
  37. 37.
    Kwakwa HA, Wahome R, Bessias S. HIV disparities in a US and foreign-bornn cohort in urban United States. J AIDS Clin Res. 2015;6:515.Google Scholar
  38. 38.
    AIDS Activities Coordinating Office (AACO) Surveillance Report 2014: HIV/AIDS in Philadelphia. City of Philadelphia Department of Public Health 2014.Google Scholar
  39. 39.
    Khawcharoenporn T, Kendrick S, Smith K. HIV risk perception and preexposure prophylaxis interest among a heterosexual population visiting a sexually transmitted infection clinic. AIDS Patient Care STDs. 2012;26(4):222–33.PubMedGoogle Scholar
  40. 40.
    Nunn A, Zaller N, Cornwall A, Mayer KH, Moore E, Dickman S, et al. Low perceived risk and high HIV prevalence among a predominantly African American population participating in Philadelphia’s rapid HIV testing program. AIDS Patient Care STDs. 2011;25(4):17.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Helena A. Kwakwa
    • 1
    Email author
  • Sophia Bessias
    • 1
  • Donielle Sturgis
    • 1
  • Natasha Mvula
    • 1
  • Rahab Wahome
    • 2
  • Catelyn Coyle
    • 3
  • Timothy P. Flanigan
    • 4
  1. 1.Division of Ambulatory Health ServicesPhiladelphia Department of Public HealthPhiladelphiaUSA
  2. 2.AIDS Care GroupSharon HillUSA
  3. 3.National Nursing Centers ConsortiumPhiladelphiaUSA
  4. 4.Division of Infectious DiseasesBrown University Alpert School of MedicineProvidenceUSA

Personalised recommendations