Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

  • Special Section: Social and Behavioral Science with Gay and Bisexual Men in the Era of Biomedical Prevention
  • Published:

Concomitant Utilization of Pre-Exposure Prophylaxis (PrEP) and Meningococcal Vaccine (MenACWY) Among Gay, Bisexual, and Other Men Who Have Sex with Men in Los Angeles County, California

  • 88 Accesses


Recent outbreaks of serogroup C meningococcal disease in Southern California have led the California Department of Public Health to recommend the quadrivalent meningococcal vaccine (MenACWY) for gay, bisexual, and other men who have sex with men (GBMSM) in Southern California. High-risk GBMSM have also been advised to utilize pre-exposure prophylaxis (PrEP) for HIV prevention. Data collected from a community-based sample of HIV-negative GBMSM in Los Angeles County (N = 476) were used in a multinomial logit regression analysis to identify patterns in MenACWY and PrEP usage and evaluate factors associated with use of both, one, or neither of these prevention methods. More than half (56%) of participants had neither been vaccinated nor used PrEP. A smaller percentage (34%) had either been vaccinated or were PrEP users, leaving 10% who had concomitant PrEP and MenACWY use. Higher education, more recent sex partners, illicit drug use, and recent receptive condomless anal sex (CAS) were significantly associated with greater odds of using both prevention methods relative to neither. Higher education, prior sexually transmitted infection diagnosis, more recent sex partners, and recent receptive CAS were significantly associated with greater odds of just PrEP use relative to neither. Higher education was the only factor significantly associated with greater odds of just MenACWY immunization relative to neither. Findings highlight important gaps in immunization among PrEP users and opportunities to screen for PrEP eligibility among GBMSM in conjunction with immunization. Public health practitioners should consider the ways in which strategies to increase PrEP and vaccine-preventable illnesses among GBMSM may complement one another.

This is a preview of subscription content, log in to check access.


  1. Atkinson, B., Gandhi, A., & Balmer, P. (2016). History of meningococcal outbreaks in the United States: Implications for vaccination and disease prevention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy,36(8), 880–892. https://doi.org/10.1002/phar.1790.

  2. Aubert, L., Taha, M., Boo, N., Le Strat, Y., Deghmane, A. E., Sanna, A., … Parent du Chatelet, I. (2015). Serogroup C invasive meningococcal disease among men who have sex with men and in gay-oriented social venues in the Paris region: July 2013 to December 2014. Euro Surveillance,20(3), 1–3.

  3. Beymer, M. R., Gildner, J. L., Holloway, I. W., & Landovitz, R. J. (2018). Acceptability of injectable and on-demand pre-exposure prophylaxis among an online sample of young men who have sex with men in California. LGBT Health,5(6), 341–349. https://doi.org/10.1089/lgbt.2017.0244.

  4. Burton, L. C., Anderson, G. F., & Kues, I. W. (2004). Using electronic health records to help coordinate care. The Milbank Quarterly,82(3), 457–481. https://doi.org/10.1111/j.0887-378X.2004.00318.x.

  5. Calabrese, S. K., Krakower, D. S., & Mayer, K. H. (2017). Integrating HIV preexposure prophylaxis (PrEP) into routine preventive health care to avoid exacerbating disparities. American Journal of Public Health,107(12), 1883–1889. https://doi.org/10.2105/ajph.2017.304061.

  6. California Department of Public Health. (2016). CDPH issues health advisory for meningococcal disease. Retrieved from https://www.cdph.ca.gov/Programs/OPA/Pages/NR16-037.aspx.

  7. California Department of Public Health. (2017). Meningococcal disease outbreak continues in Southern California. Retrieved from https://www.cdph.ca.gov/Programs/OPA/Pages/NR16-045.aspx.

  8. Callahan, E. J., Hazarian, S., Yarborough, M., & Sánchez, J. P. (2014). Eliminating LGBTIQQ health disparities: The associated roles of electronic health records and institutional culture. Hastings Center Report,44(s4), S48–S52. https://doi.org/10.1002/hast.371.

  9. Callahan, E. J., Sitkin, N., Ton, H., Eidson-Ton, W. S., Weckstein, J., & Latimore, D. (2015). Introducing sexual orientation and gender identity into the electronic health record: One academic health center’s experience. Academic Medicine,90(2), 154–160. https://doi.org/10.1097/acm.0000000000000467.

  10. Carnegie, N. B., Goodreau, S. M., Liu, A., Vittinghoff, E., Sanchez, J., Lama, J. R., & Buchbinder, S. (2015). Targeting pre-exposure prophylaxis among men who have sex with men in the United States and Peru: Partnership types, contact rates, and sexual role. Journal of Acquired Immune Deficiency Syndromes,69(1), 119–125. https://doi.org/10.1097/qai.0000000000000555.

  11. Centers for Disease Control and Prevention. (2017a). Pre-exposure prophylaxis for the prevention of HIV infection in the United States-2017 update. Retrieved from https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf.

  12. Centers for Disease Control and Prevention. (2017b). Pre-exposure prophylaxis for the prevention of HIV infection in the United States-2017 update, Clinical Providers’ Supplement. Retrieved from https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-provider-supplement-2017.pdf.

  13. Centers for Disease Control and Prevention. (2017c). Talk PrEP. Retrieved from https://www.cdc.gov/actagainstaids/campaigns/starttalking/prep.html.

  14. Centers for Disease Control and Prevention. (2018). HIV and gay and bisexual men. Retrieved from https://www.cdc.gov/hiv/group/msm/index.html.

  15. Centers for Disease Prevention and Control. (2018). HIV in the United States by geography. Retrieved from https://www.cdc.gov/hiv/statistics/overview/geographicdistribution.html.

  16. Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy,10(1), 35–42. https://doi.org/10.1007/s13178-012-0105-2.

  17. Folaranmi, T. A., Kretz, C. B., Kamiya, H., MacNeil, J. R., Whaley, M. J., Blain, A., & Meyer, S. A. (2017). Increased risk for meningococcal disease among men who have sex with men in the United States, 2012–2015. Clinical Infectious Diseases,65(5), 756–763. https://doi.org/10.1093/cid/cix438.

  18. Fuzzell, L., Fedesco, H. N., Alexander, S. C., Fortenberry, J. D., & Shields, C. G. (2016). “I just think that doctors need to ask more questions”: Sexual minority and majority adolescents’ experiences talking about sexuality with healthcare providers. Patient Education and Counseling,99(9), 1467–1472. https://doi.org/10.1016/j.pec.2016.06.004.

  19. Gallagher, T., Link, L., Ramos, M., Bottger, E., Aberg, J., & Daskalakis, D. (2014). Self-perception of HIV risk and candidacy for pre-exposure prophylaxis among men who have sex with men testing for HIV at commercial sex venues in New York City. LGBT Health,1(3), 218–224. https://doi.org/10.1089/lgbt.2013.0046.

  20. Gerard, M. N., Trick, W. E., Das, K., Charles-Damte, M., Murphy, G. A., & Benson, I. M. (2008). Use of clinical decision support to increase influenza vaccination: Multi-year evolution of the system. Journal of the American Medical Informatics Association,15(6), 776–779. https://doi.org/10.1197/jamia.M2698.

  21. Goetz, M. B., Hoang, T., Bowman, C., Knapp, H., Rossman, B., Smith, R., & The QUERI-HIV/Hepatitis Program. (2008). A system-wide intervention to improve HIV testing in the veterans health administration. Journal of General Internal Medicine,23(8), 1200–1207. https://doi.org/10.1007/s11606-008-0637-6.

  22. Graham, R., Berkowitz, B., Blum, R., Bockting, W., Bradford, J., de Vries, B., & Makadon, H. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: Institute of Medicine.

  23. Halkitis, P. N., Wolitski, R. J., & Millett, G. A. (2013). A holistic approach to addressing HIV infection disparities in gay, bisexual, and other men who have sex with men. American Psychologist,68(4), 261–273. https://doi.org/10.1037/a0032746.

  24. Hester, R. K., Squires, D. D., & Delaney, H. D. (2005). The Drinker’s check-up: 12-month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers. Journal of Substance Abuse Treatment,28(2), 159–169. https://doi.org/10.1016/j.jsat.2004.12.002.

  25. Holloway, I., Wu, E., Gildner, J., Fenimore, V., Tan, D., Randall, D., et al. (2018). Quadrivalent meningococcal vaccine uptake among men who have sex with men during a meningococcal outbreak in Los Angeles County, California 2016–2017. Public Health Reports, 133, 559–569.

  26. Hood, J. E., Buskin, S. E., Dombrowski, J. C., Kern, D. A., Barash, E. A., Katz, D. A., & Golden, M. R. (2016). Dramatic increase in preexposure prophylaxis use among MSM in Washington state. AIDS,30(3), 515–519. https://doi.org/10.1097/qad.0000000000000937.

  27. Imrey, P. B., Jackson, L. A., Ludwinski, P. H., England, A. C., 3rd, Fella, G. A., Fox, B. C., & Wenger, J. D. (1996). Outbreak of serogroup C meningococcal disease associated with campus bar patronage. American Journal of Epidemiology,143(6), 624–630.

  28. Jackson, L. A., Schuchat, A., Reeves, M. W., & Wenger, J. D. (1995). Serogroup C meningococcal outbreaks in the United States. An emerging threat. Journal of the American Medical Association,273(5), 383–389. https://doi.org/10.1001/jama.1995.03520290035026.

  29. Juusola, J. L., Brandeau, M. L., Owens, D. K., & Bendavid, E. (2012). The cost-effectiveness of preexposure prophylaxis for HIV prevention in the United States in men who have sex with men. Annals of Internal Medicine,156(8), 541–550. https://doi.org/10.7326/0003-4819-156-8-201204170-00001.

  30. Kessler, J., Myers, J. E., Nucifora, K. A., Mensah, N., Toohey, C., Khademi, A., & Braithwaite, S. (2014). Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York. AIDS,28(18), 2683–2691. https://doi.org/10.1097/qad.0000000000000460.

  31. Kim, J. J. (2010). Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis. The Lancet Infectious Diseases,10(12), 845–852. https://doi.org/10.1016/S1473-3099(10)70219-X.

  32. Kirby, T., & Thornber-Dunwell, M. (2014). Uptake of PrEP for HIV slow among MSM. The Lancet,383(9915), 399–400. https://doi.org/10.1016/S0140-6736(14)60137-9.

  33. Krakower, D. S., & Mayer, K. H. (2015). Pre-exposure prophylaxis to prevent HIV infection: Current status. Future opportunities and challenges. Drugs,75(3), 243–251. https://doi.org/10.1007/s40265-015-0355-4.

  34. Krakower, D. S., Mimiaga, M. J., Rosenberger, J. G., Novak, D. S., Mitty, J. A., White, J. M., & Mayer, K. H. (2012). 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,7(3), e33119. https://doi.org/10.1371/journal.pone.0033119.

  35. Kypri, K., Saunders, J. B., Williams, S. M., McGee, R. O., Langley, J. D., Cashell-Smith, M. L., & Gallagher, S. J. (2004). Web-based screening and brief intervention for hazardous drinking: A double-blind randomized controlled trial. Addiction,99(11), 1410–1417. https://doi.org/10.1111/j.1360-0443.2004.00847.x.

  36. Levy, S. (2014). Truvada for PrEP: Experts weigh in on the newest way to prevent HIV/AIDS: healthline. Retrieved from http://www.healthline.com/health-news/hiv-truvada-for-hiv-prevention-experts-weight-in-020714#2.

  37. Lieb, S., Fallon, S. J., Friedman, S. R., Thompson, D. R., Gates, G. J., Liberti, T. M., & Malow, R. M. (2011). Statewide estimation of racial/ethnic populations of men who have sex with men in the U.S. Public Health Reports,126(1), 60–72. https://doi.org/10.1177/003335491112600110.

  38. Los Angeles County Department of Public Health. (2016). LAC DPH health alert: Meningococcal vaccine now recommended for all men who have sex with men (MSM) [Press release]. Retrieved from http://publichealth.lacounty.gov/eprp/Health%20Alerts/LAC%20DPH%20IMD%20VAX%20MSM%20072616.pdf.

  39. Magnuson, D., Hawkins, T., & Mera, R. (2018). Adolescent use of Truvada (FTC/TDF) for HIV pre-exposure prophylaxis (PrEP) in the United States (2012–2017). Paper presented at the meeting of the International AIDS Conference, Amsterdam, The Netherlands.

  40. Marcus, J. L., Glidden, D. V., Mayer, K. H., Liu, A. Y., Buchbinder, S. P., Amico, K. R., & Grant, R. M. (2013). No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. PLoS ONE,8(12), e81997. https://doi.org/10.1371/journal.pone.0081997.

  41. Meanley, S., Gale, A., Harmell, C., Jadwin-Cakmak, L., Pingel, E., & Bauermeister, J. A. (2015). The role of provider interactions on comprehensive sexual healthcare among young men who have sex with men. AIDS Education and Prevention,27(1), 15–26. https://doi.org/10.1521/aeap.2015.27.1.15.

  42. Meites, E., Markowitz, L. E., Paz-Bailey, G., & Oster, A. M. (2014). HPV vaccine coverage among men who have sex with men—National HIV behavioral surveillance system, United States, 2011. Vaccine,32(48), 6356–6359. https://doi.org/10.1016/j.vaccine.2014.09.033.

  43. Mimiaga, M. J., Goldhammer, H., Belanoff, C., Tetu, A. M., & Mayer, K. H. (2007). Men who have sex with men: Perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sexually Transmitted Diseases,34(2), 113–119. https://doi.org/10.1097/01.olq.0000225327.13214.bf.

  44. Muhib, F. B., Lin, L. S., Stueve, A., Miller, R. L., Ford, W. L., Johnson, W. D., & Smith, P. J. (2001). A venue-based method for sampling hard-to-reach populations. Public Health Reports,116(Suppl. 1), 216–222. https://doi.org/10.1093/phr/116.S1.216.

  45. National Cancer Institute. (2003). Clear & simple: Developing effective print materials for low-literate readers. Retrieved from https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/clear-simple.

  46. Neighbors, C., Larimer, M. E., & Lewis, M. A. (2004). Targeting misperceptions of descriptive drinking norms: Efficacy of a computer-delivered personalized normative feedback intervention. Journal of Consulting and Clinical Psychology,72(3), 434–447. https://doi.org/10.1037/0022-006X.72.3.434.

  47. Office of National AIDS Policy. (2015). National HIV/AIDS strategy for the United States: Updated to 2020. Washington, DC. Retrieved from https://files.hiv.gov/s3fs-public/nhas-update.pdf.

  48. Parker, A. M., Vardavas, R., Marcum, C. S., & Gidengil, C. A. (2013). Conscious consideration of herd immunity in influenza vaccination decisions. American Journal of Preventive Medicine,45(1), 118–121. https://doi.org/10.1016/j.amepre.2013.02.016.

  49. Parsons, J. T., John, S. A., Whitfield, T. H. F., Cienfuegos-Szalay, J., & Grov, C. (2018). Human immunodeficiency virus/sexually transmitted infection counseling and testing services received by gay and bisexual men using preexposure prophylaxis at their last PrEP care visit. Sexually Transmitted Diseases,45(12), 798–802. https://doi.org/10.1097/olq.0000000000000880.

  50. Parsons, J. T., Rendina, H. J., Lassiter, J. M., Whitfield, T. H., Starks, T. J., & Grov, C. (2017). Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States. Journal of Acquired Immune Deficiency Syndromes,74(3), 285–292. https://doi.org/10.1097/qai.0000000000001251.

  51. Pérez-Figueroa, R. E., Kapadia, F., Barton, S. C., Eddy, J. A., & Halkitis, P. N. (2015). Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: The P18 study. AIDS Education and Prevention,27(2), 112–125. https://doi.org/10.1521/aeap.2015.27.2.112.

  52. Petroll, A. E., Walsh, J. L., Owczarzak, J. L., McAuliffe, T. L., Bogart, L. M., & Kelly, J. A. (2017). PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS and Behavior,21(5), 1256–1267. https://doi.org/10.1007/s10461-016-1625-1.

  53. Pitasi, M. A., Bingham, T. A., Sey, E. K., Smith, A. J., & Teshale, E. H. (2014). Hepatitis B virus (HBV) infection, immunity and susceptibility among men who have sex with men (MSM), Los Angeles County, USA. AIDS and Behavior,18(3), 248–255. https://doi.org/10.1007/s10461-013-0670-2.

  54. POZ. (2018). Just 15% of those who’ve started PrEP are younger than 25. Retrieved from https://www.poz.com/article/just-15-whove-started-prep-younger-25.

  55. Rhodes, S. D., & Hergenrather, K. C. (2002). Exploring hepatitis B vaccination acceptance among young men who have sex with men: Facilitators and barriers. Preventive Medicine,35(2), 128–134. https://doi.org/10.1006/pmed.2002.1047.

  56. Rudy, E. T., Detels, R., Douglas, W., & Greenland, S. (2003). Factors affecting hepatitis vaccination refusal at a sexually transmitted disease clinic among men who have sex with men. Sexually Transmitted Diseases,30(5), 411–418.

  57. Sanchez, T. H., Sineath, R. C., Kahle, E. M., Tregear, S. J., & Sullivan, P. S. (2015). The annual American men’s internet survey of behaviors of men who have sex with men in the United States: Protocol and key indicators report 2013. JMIR Public Health and Surveillance,1(1), e3. https://doi.org/10.2196/publichealth.4314.

  58. Schutten, M., de Wit, J. B. F., & van Steenbergen, J. E. (2002). Why do gay men want to be vaccinated against hepatitis B? An assessment of psychosocial determinants of vaccination intention. International Journal of STD and AIDS,13(2), 86–90. https://doi.org/10.1258/0956462021924703.

  59. Smith, D. K., Pals, S. L., Herbst, J. H., Shinde, S., & Carey, J. W. (2012a). Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. Journal of Acquired Immune Deficiency Syndromes,60(4), 421–427. https://doi.org/10.1097/QAI.0b013e318256b2f6.

  60. Smith, D. K., Toledo, L., Smith, D. J., Adams, M. A., & Rothenberg, R. (2012b). Attitudes and program preferences of African–American urban young adults about pre-exposure prophylaxis (PrEP). AIDS Education and Prevention,24(5), 408–421. https://doi.org/10.1521/aeap.2012.24.5.408.

  61. Thomas, E. A., & Goldstone, S. E. (2011). Should I or Shouldn’t I: Decision making, knowledge and behavioral effects of quadrivalent HPV vaccination in men who have sex with men. Vaccine,29(3), 570–576. https://doi.org/10.1016/j.vaccine.2010.09.101.

  62. Weiss, D., & Varma, J. K. (2013). Control of recent community-based outbreaks of invasive meningococcal disease in men who have sex with men in Europe and the United States. Eurosurveillance,18(28), 20522. https://doi.org/10.2807/1560-7917.ES2013.18.28.20522.

  63. Zablotska, I. B. (2017). Likely impact of pre-exposure prophylaxis on HIV epidemics among men who have sex with men. Sexual Health,14(1), 97–105. https://doi.org/10.1071/sh16153.

Download references


This study was funded by the University of California HIV/AIDS Research Program (Grant Number RP15-LA-007). Additional support was provided by the UCLA Center for HIV, Identification, Prevention, and Treatment Services funded by the National Institute of Mental Health (Grant Number P30MH058107) and Emory Center for AIDS Research. We would like to express our gratitude to all participants in this study and to our data collection team from the Luskin School of Public Affairs. We would also like to thank Michelle Parra, Laurel Fowler, Franklin Pratt, and Kathleen Sanchez from the Los Angeles County Department of Public Health Immunization Program, and Adam Cohen from AIDS Healthcare Foundation for their valuable contributions.

Author information

Correspondence to Ian W. Holloway.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study 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.

Informed Consent

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

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Holloway, I.W., Tan, D., Bednarczyk, R.A. et al. Concomitant Utilization of Pre-Exposure Prophylaxis (PrEP) and Meningococcal Vaccine (MenACWY) Among Gay, Bisexual, and Other Men Who Have Sex with Men in Los Angeles County, California. Arch Sex Behav 49, 137–146 (2020). https://doi.org/10.1007/s10508-019-01500-4

Download citation


  • PrEP
  • Meningitis
  • Vaccination
  • Men who have sex with men
  • Sexual orientation