Attitudes Toward HIV Pre-Exposure Prophylaxis in a United States Urban Clinic Population
- 930 Downloads
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.
KeywordsPrEP HIV Urban Attitudes US
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.
No funding was received for this study.
- 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
- 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.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.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.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.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
- 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
- 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
- 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.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.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
- 28.Aragon TJ. Epitools: Epidemiology Tools. R package version 0.5-7 2012. https://CRAN.R-project.org/package=epitools.
- 29.Fox J, Weisberg S. An R companion to applied Regression, Second Edition. Thousand Oaks: Sage. http://socserv.socsci.mcmaster.ca/jfox/Books/Companion.
- 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/.
- 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.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.AIDS Activities Coordinating Office (AACO) Surveillance Report 2014: HIV/AIDS in Philadelphia. City of Philadelphia Department of Public Health 2014.Google Scholar