Advertisement

AIDS and Behavior

, Volume 23, Issue 10, pp 2694–2705 | Cite as

Prevalence and Correlates of PrEP Awareness and Use Among Black Men Who Have Sex with Men and Women (MSMW) in the United States

  • M. Reuel FriedmanEmail author
  • Jordan M. Sang
  • Leigh A. Bukowski
  • Cristian J. Chandler
  • James E. Egan
  • Lisa A. Eaton
  • Derrick D. Matthews
  • Ken Ho
  • Henry F. Raymond
  • Ron Stall
Original Paper
  • 305 Downloads

Abstract

Men who have sex with men and women (MSMW), including those who are Black, experience HIV-related disparities compared to men who have sex with men only (MSMO). Few studies have assessed the prevalence and correlates of pre-exposure prophylaxis (PrEP) awareness and use among Black MSMW. We recruited MSM ≥ 18 attending Black Gay Pride events between 2014–2017. We conducted multivariable logistic regressions to assess differences in PrEP awareness and use among HIV-negative Black MSM (n = 2398) and within Black MSMW (n = 419). MSMW were less likely than MSMO to report PrEP awareness (p < 0.001). Among PrEP-aware MSM, MSMW were more likely than MSMO to report PrEP use (p < 0.05). MSMW receiving gay community support were more likely to be PrEP-aware (p < 0.01). MSMW reporting any past-year STI diagnoses were more likely to report PrEP use (p < 0.01). Findings suggest that PrEP awareness campaigns tailored for Black MSMW, concomitant with STI-to-PrEP interventions, will facilitate greater PrEP uptake in this population.

Keywords

HIV prevention Pre-exposure prophylaxis Black/African American Men who have sex with men (MSM) Bisexuality 

Resumen

Los hombres que tienen sexo con hombres y mujeres (MSMW, siglas in Inglés), incluyendo los que son Negros, experimentan disparidades relacionadas con el VIH en comparación con los hombres que tienen sexo con hombres solamente (MSMO, siglas en Inglés). Pocos estudios han evaluado la prevalencia y los correlatos de el conocimiento y el uso de la profilaxis pre-exposición (PrEP, siglas in Inglés) entre los MSMW Negros. Reclutamos a hombres que tienen sexo con hombres, o MSM (siglas en Inglés) ≥18 que asistieron a eventos del Orgullo Gay Negro entre 2014—2017. Realizamos regresiones logísticas multivariables para evaluar las diferencias en el conocimiento y uso de PrEP entre los MSM Negros VIH-negativos (n=2398) y dentro de los MSMW Negros (n=419). Los MSMW fueron menos probables que los MSMO a reportar sobre el conocimiento de la PrEP (p<.001). Entre los MSM con reconocimiento de PrEP, los MSMW fueron más probables que los MSMO a reportar el uso de PrEP (p<.05). Los MSMW que recibieron apoyo de la comunidad gay tenían más probabilidades de ser conscientes de la PrEP (p<.01). Los MSMW que informaron sobre cualquier diagnóstico de ITS el año anterior tenían más probabilidades de informar el uso de PrEP (p <.01). Los hallazgos sugieren que las campañas de concientización sobre la PrEP adaptadas para los MSMW Negros, concomitantes con las intervenciones de ITS-a-PrEP, facilitarán una mayor captación de PrEP en esta populación.

Notes

Acknowledgements

The authors thank the Center for Black Equity and local Black Pride organizations for partnering with us to implement POWER, the community-based organizations who performed onsite HIV testing on the study’s behalf, the thousands of study participants who volunteered their time to contribute to this research, and members of the POWER Study Team who made data collection possible. The local Black Pride organizations are as follows: D.C. Black Pride, Detroit’s Hotter than July, Houston Splash, In the Life Atlanta, Memphis Black Pride, and Philadelphia Black Pride. The community-based organizations that performed onsite HIV testing are as follows: Atlanta: AID Atlanta, AIDS Health Care Foundation, NAESM; Detroit: Community Health Awareness Group, Horizons Project, Unified; Houston: Avenue 360, Houston AIDS Foundation, Positive Efforts; Memphis: Friends for Life; Philadelphia: Access Matters, Philadelphia FIGHT; Washington, D.C.: Us Helping Us. The members of POWER study team are as follows: Center for Black Equity: Earl D. Fowlkes, Jr., Michael S. Hinson, Jr.; Columbia University: Patrick A. Wilson; University of Connecticut: Lisa A. Eaton; Rutgers University: Henry Fisher-Raymond; University of Pittsburgh: Leigh A. Bukowski, Cristian J. Chandler, Derrick D. Matthews, Steven P. Meanley, Jordan M. Sang, and Ronald D. Stall. We are grateful to Luis Archila for his translation of our abstract into Spanish.

Funding

This study was funded by the National Institutes of Minority Health and Health Disparities, National Institutes of Health (5R01NR013865).

Compliance with Ethical Standards

Conflict of interest

Author MRF has received an honorarium and travel expenses reimbursement for serving as a consultant to Gilead Sciences, Inc. in June 2018 for the purposes of providing scientific input for a grant mechanism in development concentrating on HIV and aging. Authors MRF and RDS received travel expenses reimbursements from Gilead Sciences, Inc. for the purposes of speaking at AIDSImpact conference in July 2015, specifically for a symposium on syndemics and the HIV prevention and care continuum. Authors JMS, LAB, DDM, LAE, CJC, JEE, KH, and HRF have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the University of Pittsburgh Human Research Protection Office (protocol number PRO13110137).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2019_2446_MOESM1_ESM.pdf (156 kb)
Supplementary material 1 (PDF 155 kb)

References

  1. 1.
    Centers for Disease Control and Prevention. HIV among African American gay and bisexual men 2018. https://www.cdc.gov/hiv/group/msm/bmsm.html (2018). Accessed 27 March 2018.
  2. 2.
    Friedman MR, Coulter RW, Silvestre AJ, Stall R, Teplin L, Shoptaw S, Surkan PJ, Plankey MW. Someone to count on: social support as an effect modifier of viral load suppression in a prospective cohort study. AIDS Care. 2016;29:1–12.Google Scholar
  3. 3.
    Friedman MR, Stall R, Silvestre AJ, Wei C, Shoptaw S, Herrick A, et al. Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study. AIDS. 2015;29(9):1087–96.CrossRefGoogle Scholar
  4. 4.
    Underhill K, Morrow KM, Colleran C, Calabrese SK, Operario D, Salovey P, et al. Explaining the efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention: a qualitative study of message framing and messaging preferences among US men who have sex with men. AIDS Behav. 2016;20(7):1514–26.CrossRefGoogle Scholar
  5. 5.
    Arrington-Sanders R, Morgan A, Oidtman J, Qian I, Celentano D, Beyrer C. A medical care missed opportunity: preexposure prophylaxis and young Black men who have sex with men. J Adolesc Health. 2016;59(6):725–8.CrossRefGoogle Scholar
  6. 6.
    Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J. Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and Interest in using PrEP among Black and White men and transgender women who have sex with men. AIDS Behav. 2017;21(5):1236–46.CrossRefGoogle Scholar
  7. 7.
    Kuhns LM, Hotton AL, Schneider J, Garofalo R, Fujimoto K. Use of pre-exposure prophylaxis (PrEP) in young men who have sex with men is associated with race, sexual risk behavior and peer network size. AIDS Behav. 2017;21(5):1376–82.CrossRefGoogle Scholar
  8. 8.
    Hoots BE, Finlayson T, Nerlander L, Paz-Bailey G, National HIV Behavioral Surveillance Study Group. Willingness to take, use of, and indications for pre-exposure prophylaxis among men who have sex with men-20 US cities, 2014. Clin Infectious Dis. 2016;63(5):672–7.CrossRefGoogle Scholar
  9. 9.
    Philbin MM, Parker CM, Parker RG, Wilson PA, Garcia J, Hirsch JS. The promise of pre-exposure prophylaxis for Black men who have sex with men: an ecological approach to attitudes, beliefs, and barriers. AIDS Patient Care STDs. 2016;30(6):282–90.CrossRefGoogle Scholar
  10. 10.
    Brooks RA, Kaplan RL, Lieber E, Landovitz RJ, Lee S-J, 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.CrossRefGoogle Scholar
  11. 11.
    Brooks RA, Landovitz RJ, Kaplan RL, Lieber E, Lee S-J, Barkley TW. Sexual risk behaviors and acceptability of hiv pre-exposure prophylaxis among hiv-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. AIDS Patient Care STDs. 2012;26(2):87–94.CrossRefGoogle Scholar
  12. 12.
    Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in Black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1352–8.CrossRefGoogle Scholar
  13. 13.
    Friedman MR, Dodge BM. The role of syndemic in explaining health disparities among bisexual men: a blueprint for a theoretically informed perspective. In: Wright ER, Carnes N, editors. Understanding the HIV/AIDS epidemic in the United States. Cham: Springer; 2016. p. 71–98.CrossRefGoogle Scholar
  14. 14.
    McCree DH, Oster AM, Jeffries WL IV, Denson DJ, Lima AC, Whitman H, et al. HIV acquisition and transmission among men who have sex with men and women: what we know and how to prevent it. Prev Med. 2017;100:132–4.CrossRefGoogle Scholar
  15. 15.
    Jeffries WL IV. Beyond the bisexual bridge: sexual health among US men who have sex with men and women. Am J Prev Med. 2014;47(3):320–9.CrossRefGoogle Scholar
  16. 16.
    Grov C, Whitfield THF, Rendina HJ, Ventuneac A, Parsons JT. Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS Behav. 2015;19(12):2234–44.CrossRefGoogle Scholar
  17. 17.
    Parsons JT, Rendina HJ, Whitfield THF, Grov C. Familiarity with and preferences for oral and long-acting injectable HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the U.S. AIDS Behav. 2016;20(7):1390–9.CrossRefGoogle Scholar
  18. 18.
    Rendina HJ, Whitfield TH, Grov C, Starks TJ, Parsons JT. Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): findings from a large cohort of gay and bisexual men in the U.S. Soc Sci Med. 2017;172:115–23.CrossRefGoogle Scholar
  19. 19.
    Friedman MR, Stall R, Silvestre AJ, Mustanski B, Shoptaw S, Surkan PJ, et al. Stuck in the middle: longitudinal HIV-related health disparities among men who have sex with men and women. JAIDS J Acquir Immune Defic Syndr. 2014;66(2):213–20.CrossRefGoogle Scholar
  20. 20.
    Friedman MR, Bukowski L, Eaton LA, Matthews DD, Dyer TV, Siconolfi D, et al. Psychosocial health disparities among Black bisexual men in the US: effects of sexuality nondisclosure and gay community support. Arch Sex Behav. 2018;48:213–24.CrossRefGoogle Scholar
  21. 21.
    Friedman MR, Sang JM, Bukowski LA, Matthews DD, Eaton LA, Raymond HF, et al. HIV care continuum disparities among Black bisexual men and the mediating effect of psychosocial comorbidities. JAIDS J Acquir Immune Defic Syndr. 2018;77(5):451–8.CrossRefGoogle Scholar
  22. 22.
    Sang JM, Matthews DD, Meanley SP, Eaton LA, Stall RD. Assessing HIV stigma on prevention strategies for Black men who have sex with men in the United States. AIDS Behav. 2018;22:3879–86.CrossRefGoogle Scholar
  23. 23.
    Singh S, Hu X, Wheeler W, Hall HI. HIV diagnoses among men who have sex with men and women—United States and 6 dependent areas, 2008-2011. Am J Public Health. 2014;104(9):1700–6.CrossRefGoogle Scholar
  24. 24.
    Hacker E, Cohn J, Golden MR, Heumann C, editors. HIV pre-exposure prophylaxis (PrEP) uptake, initiation, and persistence in the Detroit Public Health STD Clinic. Open forum infectious diseases. New York: Oxford University Press; 2017.Google Scholar
  25. 25.
    Weiss G, Smith D, Ye J, Newman S, Kitlas A, editors. Implementing PrEP in STD clinics: findings from a 2015 assessment of local health department engagement in PrEP implementation. In: 2016 national STD prevention conference. Atlanta: CDC; 2016.Google Scholar
  26. 26.
    Liu A, Cohen S, Follansbee S, Cohan D, Weber S, Sachdev D, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Med. 2014;11(3):e1001613.CrossRefGoogle Scholar
  27. 27.
    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.CrossRefGoogle Scholar
  28. 28.
    Bukowski LA, Chandler CJ, Creasy SL, Matthews DD, Friedman MR, Stall RD. Characterizing the HIV care continuum and identifying barriers and facilitators to HIV diagnosis and viral suppression among Black transgender women in the United States. J Acquir Immune Defic Syndr. 2018;79:413–20.CrossRefGoogle Scholar
  29. 29.
    Eaton LA, Matthews DD, Driffin DD, Bukowski L, Wilson PA, Stall RD, et al. A multi-US city assessment of awareness and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black men and transgender women who have sex with men. Prev Sci. 2017;18(5):505–16.CrossRefGoogle Scholar
  30. 30.
    Chandler C, Bukowski L, Matthews D, Egan J, Hawk M, Markovic N, et al. Documenting differences among BMSM at risk for HIV: BMSM using and not using PrEP in the POWER study AIDS education and prevention. JAIDS J Acquir Immune Defic Syndr. 2018;79:339–46.CrossRefGoogle Scholar
  31. 31.
    Hoyle RH. Handbook of structural equation modeling. New York: Guilford press; 2012.Google Scholar
  32. 32.
    Kline RB. Principles and practice of structural equation modeling. New York: Guilford; 2015.Google Scholar
  33. 33.
    Smith D, editor. Abstract 86. Conference on retroviruses and opportunistic infections. Boston: Hynes Convention Center; 2018.Google Scholar
  34. 34.
    Eaton LA, Driffin DD, Bauermeister J, Smith H, Conway-Washington C. Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, Black men who have sex with men. AIDS Patient Care STDs. 2015;29(8):423–9.CrossRefGoogle Scholar
  35. 35.
    Feinstein BA, Dyar C. Bisexuality, minority stress, and health. Curr Sex Health Rep. 2017;9(1):42–9.CrossRefGoogle Scholar
  36. 36.
    Friedman MR, Dodge B, Schick V, Herbenick D, Hubach RD, Bowling J, et al. From bias to bisexual health disparities: attitudes toward bisexual men and women in the United States. LGBT Health. 2014;1(4):309–18.CrossRefGoogle Scholar
  37. 37.
    Dodge B, Jeffries WL, Sandfort TG. Beyond the down low: sexual risk, protection, and disclosure among at-risk Black men who have sex with both men and women (MSMW). Arch Sex Behav. 2008;37(5):683–96.CrossRefGoogle Scholar
  38. 38.
    Malebranche DJ. Bisexually active Black men in the United States and HIV: acknowledging more than the “down low”. Arch Sex Behav. 2008;37(5):810–6.CrossRefGoogle Scholar
  39. 39.
    Beach L, Bartelt E, Dodge B, Bostwick W, Schick V, Fu TJ, et al. Meta-perceptions of others’ attitudes toward bisexual men and women among a nationally representative probability sample. Arch Sex Behav. 2018;48:191–7.CrossRefGoogle Scholar
  40. 40.
    Pathela P, Braunstein SL, Blank S, Schillinger JA. HIV incidence among men with and those without sexually transmitted rectal infections: estimates from matching against an HIV case registry. Clin Infect Dis. 2013;57(8):1203–9.CrossRefGoogle Scholar
  41. 41.
    United States Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 update. In: Prevention CfDCa, 2017.Google Scholar
  42. 42.
    Jill-Garland D. Pennsylvania Department of Health, Division of HIV Disease. Personal Communication; 2018.Google Scholar
  43. 43.
    Montano MA, Dombrowski JC, Barbee LA, Golden MR, Khosropour CM. Changes in sexual behavior and STI diagnoses among MSM using PrEP in Seattle, WA. Age. 2017;30(8):7.Google Scholar
  44. 44.
    Harawa NT, Holloway IW, Leibowitz A, Weiss R, Gildner J, Landovitz RJ, et al. Serious concerns regarding a meta-analysis of preexposure prophylaxis use and STI acquisition. AIDS. 2017;31(5):739.CrossRefGoogle Scholar
  45. 45.
    Kojima N, Davey DJ, Klausner JD. Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men. AIDS. 2016;30(14):2251–2.CrossRefGoogle Scholar
  46. 46.
    Friedman MR, Wei C, Klem ML, Silvestre AJ, Markovic N, Stall R. HIV infection and sexual risk among men who have sex with men and women (MSMW): a systematic review and meta-analysis. PLoS ONE. 2014;9(1):e87139.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • M. Reuel Friedman
    • 1
    • 2
    Email author
  • Jordan M. Sang
    • 2
    • 3
  • Leigh A. Bukowski
    • 2
    • 3
  • Cristian J. Chandler
    • 4
  • James E. Egan
    • 2
    • 3
  • Lisa A. Eaton
    • 5
  • Derrick D. Matthews
    • 6
  • Ken Ho
    • 7
  • Henry F. Raymond
    • 8
  • Ron Stall
    • 2
    • 3
  1. 1.Department of Infectious Diseases and Microbiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  2. 2.Center for LGBT Health Research, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  3. 3.Department of Behavioral and Community Health Sciences, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  4. 4.Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaUSA
  5. 5.Department of Human Development and Family StudiesUniversity of ConnecticutHartfordUSA
  6. 6.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  7. 7.Division of Infectious Diseases, School of MedicineUniversity of PittsburghPittsburghUSA
  8. 8.Department of Biostatistics and Epidemiology, School of Public HealthRutgers UniversityPiscatawayUSA

Personalised recommendations