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
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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.
KeywordsBlack men and transgender women HIV prevention Pre-exposure prophylaxis
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.
This study was partially supported by the National Institute for Nursing Research (R01NR013865) and the National Institute for Mental Health (R01MH094230).
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 was obtained from all individual participants included in the study.
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