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Prevention Science

, Volume 18, Issue 5, pp 505–516 | Cite as

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

  • Lisa A. EatonEmail author
  • Derrick D. Matthews
  • Daniel D. Driffin
  • Leigh Bukowski
  • Patrick A. Wilson
  • Ron D. Stall
  • The POWER Study Team
Article

Abstract

The HIV epidemic among Black men and transgender women who have sex with men (BMTW) demands an urgent public health response. HIV point prevalence among this population ranges from 25 to 43%—a rate far exceeding any other group. Pre-exposure prophylaxis (PrEP) for HIV prevention is a very promising prevention tool; however, its full potential to slow the epidemic has yet to be realized. For the current study, random time-location sampling at Black Gay Pride Events was used to collect data from N = 1274 BMTW, from five US cities, reporting HIV-negative/unknown status. In-field HIV testing was also provided to participants. Participants were assessed on awareness and use of PrEP, health care factors, HIV testing history, psychosocial variables, and sex behaviors. About one third of participants were aware of PrEP (39%), and a small percentage of participants were users of PrEP (4.6%). In multivariable analyses, being in a relationship, testing for HIV in the past 6 months, and others being aware of one’s sexuality were positively associated with PrEP awareness. Higher levels of internalized homophobia and greater numbers of female sex partners were positively associated with PrEP use, while education and condom use were negatively associated. Based on study findings, messaging and uptake of PrEP needs greater expansion and requires novel approaches for scale-up. Improving linkage to HIV testing services is likely critical for engaging BMTW with PrEP. The potential for PrEP to slow the HIV epidemic is high; however, we must strengthen efforts to ensure universal availability and uptake.

Keywords

Black men and transgender women HIV prevention Pre-exposure prophylaxis 

Notes

Acknowledgements

This study was partially supported by the National Institute for Nursing Research (R01NR013865) and the National Institute for Mental Health (R01MH094230). The members of the POWER Study Team are as follows: Center for Black Equity: Earl D. Fowlkes, Jr., and Michael S. Hinson, Jr.; Columbia University: Alexander J. Martos and Patrick A. Wilson; University of Connecticut: Robert Baldwin, Christopher Conway-Washington, Daniel D. Driffin, Lisa A. Eaton, Harlan Smith, Chauncey Cherry, and Sabrina Cherry; and University of Pittsburgh: Patrick Buehler, Leigh Bukowski, Amy L. Herrick, Christopher Hoffmann, Derrick D. Matthews, Marcus A. Poindexter, Noah Riley, Ron D. Stall, Orrin Tiberi, Mudia Uzzi, Maurice Goodwin, and Steven Meanley.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

This study was partially supported by the National Institute for Nursing Research (R01NR013865) and the National Institute for Mental Health (R01MH094230).

Ethical Approval

This study received the IRB approval from the University of Pittsburgh, the University of Connecticut, and the Columbia University. 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.

Informed Consent

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

References

  1. Al-Tayyib, A. A., Thrun, M. W., Haukoos, J. S., & Walls, N. E. (2014). Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men in Denver, Colorado. AIDS & Behavior, 18, 340–347.CrossRefGoogle Scholar
  2. Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.PubMedGoogle Scholar
  3. Auerbach, J. D., & Hoppe, T. A. (2015). Beyond “getting drugs into bodies”: Social science perspectives on pre-exposure prophylaxis for HIV. Journal of the International AIDS Society, 18, 19983.CrossRefPubMedPubMedCentralGoogle Scholar
  4. AVAC.org. (2015). Global Advocacy for HIV Prevention. http://www.avac.org/prep/track-research. Accessed January 13, 2015.
  5. Bauermeister, J. A., Meanley, S., Pingel, E., Soler, J. H., & Harper, G. W. (2013). PrEP awareness and perceived barriers among single young men who have sex with men. Current HIV/AIDS Research, 11, 520–527.CrossRefGoogle Scholar
  6. Brooks, R., & Allen, V. (2014). Acceptability of HIV pre-exposure prophylaxis (PrEP) at varying levels of effectiveness among low SES black gay and bisexual men in Los Angeles: Implications for PrEP dissemination. 9th International Conference on HIV Treatment and Prevention Adherence. IAPAC, Miami, FL.Google Scholar
  7. Brooks, R. A., Kaplan, R. L., Lieber, E., Landovitz, R. J., Lee, S. J., & Leibowitz, A. A. (2011). Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care, 23, 1136–1145.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Burress, J. (2014). ‘Truvada whore’ stigma endures among doctors and LGBTs. The Advocate. http://www.advocate.com/health/2014/08/11/truvada-whore-stigma-endures-among-doctors-and-lgbts.
  9. Bursac, Z., Gauss, C. H., Williams, D. K., & Hosmer, D. W. (2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine, 3, 17.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Caceres, C. F., O’Reilly, K. R., Mayer, K. H., & Baggaley, R. (2015). PrEP implementation: Moving from trials to policy and practice. Journal of the International AIDS Society, 18, 20222.PubMedPubMedCentralGoogle Scholar
  11. Carrillo, J. E., Carrillo, V. A., Perez, H. R., Salas-Lopez, D., Natale-Pereira, A., & Byron, A. T. (2011). Defining and targeting health care access barriers. Journal of Health Care for the Poor and Underserved, 22, 562–575.CrossRefPubMedGoogle Scholar
  12. Cohen, S. E., Liu, A. Y., Bernstein, K. T., & Philip, S. (2013). Preparing for HIV pre-exposure prophylaxis: Lessons learned from post-exposure prophylaxis. American Journal of Preventive Medicine, 44, S80–85.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Cohen, S. E., Vittinghoff, E., Bacon, O., Doblecki-Lewis, S., Postle, B.S., Feaster, D…Liu, A.Y. (2015). 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. Journal of Acquired Immune Deficiency Syndrome, 68, 439–448.Google Scholar
  14. Cremin, I., Alsallaq, R., Dybul, M., Piot, P., Garnett, G., & Hallett, T. B. (2013). The new role of antiretrovirals in combination HIV prevention: A mathematical modelling analysis. AIDS, 27, 447–458.CrossRefPubMedGoogle Scholar
  15. Duran, D. (2012). Truvada whores? Huffpost Gay Voices. http://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html. Accessed January 3, 2015.
  16. Dutta, M. J. (2013). Disseminating HIV pre-exposure prophylaxis information in underserved communities. American Journal of Preventive Medicine, 44, S133–136.CrossRefPubMedGoogle Scholar
  17. Eaton, L. A., Driffin, D. D., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2014). Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event. Sexual Health, 11, 244–251.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Eaton, L. A., Driffin, D. D., Bauermeister, J., Smith, H., & Conway-Washington, C. (2015). 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, 29, 423–9.CrossRefGoogle Scholar
  19. Gamarel, K. E., & Golub, S. A. (2015). Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Annals of Behavioral Medicine, 49, 177–186.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Glazek, C. (2014). Why I am a Truvada whole. OUT. http://www.out.com/entertainment/popnography/2014/05/20/why-i-am-truvada-whore. Accessed January 3, 2015.
  21. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L…iPrex Study Team. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599.Google Scholar
  22. Hammer, G. P., Kellogg, T. A., McFarland, W. C., Wong, E., Louie, B., Williams, I…Klausner, J. D. (2003). Low incidence and prevalence of hepatitis C virus infection among sexually active non-intravenous drug-using adults, San Francisco, 1997–2000. Sexually Transmitted Diseases, 30, 919–924.Google Scholar
  23. Herbst, J. H., Jacobs, E. D., Finlayson, T. J., Mckleroy, V. S., Crepaz, N., & HIV/AIDS Prevention Research Synthesis Team. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS & Behavior, 12, 1–17.CrossRefGoogle Scholar
  24. Hurt, C. B., Eron, J. J., Jr., & Cohen, M. S. (2011). Pre-exposure prophylaxis and antiretroviral resistance: HIV prevention at a cost? Clinical Infectious Diseases, 53, 1265–1270.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Kalichman, S. C. (1998). Post-exposure prophylaxis for HIV infection in gay and bisexual men. Implications for the future of HIV prevention. American Journal of Preventive Medicine, 15, 120–127.CrossRefPubMedGoogle Scholar
  26. Katz, M. H., & Gerberding, J. L. (1997). Postexposure treatment of people exposed to the human immunodeficiency virus through sexual contact or injection-drug use. New England Journal of Medicine, 336, 1097–1100.CrossRefPubMedGoogle Scholar
  27. Kirby, T., & Thornber-Dunwell, M. (2014). Uptake of PrEP for HIV slow among MSM. Lancet, 383, 399–400.CrossRefPubMedGoogle Scholar
  28. Koblin, B. A., Mayer, K. H., Eshleman, S. H., Wang, L., Mannheimer, S., del Rio, C….HPTN 061 Protocol Team. (2013). Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS One, 8, e70413.Google Scholar
  29. 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, e33119.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Kurtz, S. P., Buttram, M. E., & Surratt, H. L. (2014). Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA. AIDS Care, 26, 411–415.CrossRefPubMedGoogle Scholar
  31. Liu, A. Y., Kittredge, P. V., Vittinghoff, E., Raymond, H. F., Ahrens, K., Matheson, T …Buchbinder, S. P. (2008). Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men. Journal of Acquired Immune Deficiency Syndrome, 47, 241–247.Google Scholar
  32. Liu, A., Cohen, S., Follansbee, S., Cohan, D., Weber, S., Sachdev, D., & Buchbinder, S. (2014). Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Medicine, 11, e1001613.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Lurie, P., Miller, S., Hecht, F., Chesney, M., & Lo, B. (1998). Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical, and policy considerations. Journal of the American Medical Association, 280, 1769–1773.CrossRefPubMedGoogle Scholar
  34. Matthews, D. D., Herrick, A. L., Coulter, R. W., Friedman, M. R., Mills, T. C., Eaton, L. A…POWER Study Team (2015). Running backwards: Consequences of current HIV incidence rates for the next generation of Black MSM in the United States. AIDS & Behavior, 20:7–16.Google Scholar
  35. Mayer, K. H., & Krakower, D. S. (2015). Editorial commentary: Scaling up antiretroviral preexposure prophylaxis: moving from trials to implementation. Clinical Infectious Diseases, 61, 1598–600.CrossRefPubMedPubMedCentralGoogle Scholar
  36. McCormack, S., & Dunn, D. (2015). Pragmatic open-label randomised trial of preexposure prophylaxis: The PROUD Study. Conference on Retroviruses and Opportunistic Infections. AIS-USA, Seattle, Washington.Google Scholar
  37. Mehta, S. A., Silvera, R., Bernstein, K., Holzman, R. S., Aberg, J. A., & Daskalakis, D. C. (2011). Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City. Sexually Transmitted Infections, 87, 344–348.CrossRefPubMedGoogle Scholar
  38. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefPubMedGoogle Scholar
  39. Molina, J., Capitant, C., Spire, B., Pialoux, G., Chidiac, C., Charreau, I…Delfraissy, J. F. (2015). On demand PrEP with oral TDF-FTC in MSM: Results of the ANRS Ipergay Trial. Conference on Retroviruses and Opportunistic Infections. AIS-USA, Seattle, Washington.Google Scholar
  40. Mutchler, M. G., McDavitt, B., Ghani, M. A., Nogg, K., Winder, T. J., & Soto, J. K. (2015). Getting PrEPared for HIV prevention navigation: Young Black gay men talk about HIV prevention in the biomedical era. AIDS Patient Care & STDS, 29, 490–502.CrossRefGoogle Scholar
  41. Norton, W. E., Larson, R. S., & Dearing, J. W. (2013). Primary care and public health partnerships for implementing pre-exposure prophylaxis. American Journal of Preventive Medicine, 44, S77–79.CrossRefPubMedGoogle Scholar
  42. PRePWatch. 2016. http://www.prepwatch.org/. Accessed January 25, 2016.
  43. Purcell, D. W., Johnson, C. H., Lansky, A., Prejean, J., Stein, R., Denning, P…Crepaz, N. (2012). Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS Journal, 6, 98–107.Google Scholar
  44. Rosenberg, E. S., Millett, G. A., Sullivan, P. S., Del Rio, C., & Curran, J. W. (2014). Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: A modeling study. Lancet HIV, 1, e112–e118.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Rucinski, K. B., Mensah, N. P., Sepkowitz, K. A., Cutler, B. H., Sweeney, M. M., & Myers, J. E. (2013). Knowledge and use of pre-exposure prophylaxis among an online sample of young men who have sex with men in New York City. AIDS & Behavior, 17, 2180–2184.CrossRefGoogle Scholar
  46. Saberi, P., Gamarel, K. E., Neilands, T. B., Comfort, M., Sheon, N., Darbes, L. A., & Johnson, M. O. (2012). Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: A mixed methods study. PLoS One, 7, e50061.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Smith, D. K., Grohskopf, L. A., Black, R. J., Auerbach, J. D., Veronese, F., Struble, K. A…US Department of Health and Human Services. (2005). Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services. Morbidity & Mortality Weekly Report, 54(RR-2), 1–20.Google Scholar
  48. Sullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A…Sanchez, T. H. (2014). Understanding racial HIV/STI disparities in black and white men who have sex with men: A multilevel approach. PLoS One, 9, e90514.Google Scholar
  49. Turner, K. R., McFarland, W., Kellogg, T. A., Wong, E., Page-Shafer, K., Louie, B…Klausner, J. (2003). Incidence and prevalence of herpes simplex virus type 2 infection in persons seeking repeat HIV counseling and testing. Sexually Transmitted Diseases, 30, 331–334.Google Scholar
  50. Wagnild, G. (2009). The Resilience Scale user’s guide for the US English version of the Resilience Scale and the 14-item Resilience Scale (RS-14). The Resilience Center.Google Scholar

Copyright information

© Society for Prevention Research 2017

Authors and Affiliations

  • Lisa A. Eaton
    • 1
    Email author
  • Derrick D. Matthews
    • 2
  • Daniel D. Driffin
    • 1
  • Leigh Bukowski
    • 2
  • Patrick A. Wilson
    • 3
  • Ron D. Stall
    • 2
  • The POWER Study Team
    • 1
    • 2
    • 3
  1. 1.Center for Health, Intervention and PreventionUniversity of ConnecticutStorrsUSA
  2. 2.University of PittsburghPittsburghUSA
  3. 3.Columbia UniversityNew YorkUSA

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