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The Role of Social Relationships in PrEP Uptake and Use Among Transgender Women and Men Who Have Sex with Men


Qualitative studies suggest that social relationships play an important role in HIV pre-exposure prophylaxis (PrEP) use, but there have been few quantitative assessments of the role of social relationships in PrEP uptake or adherence. We examined the association between disclosure of study participation or LGBT identity and PrEP use in the 1603 HIV-negative participants enrolled in the iPrEx OLE study. We also evaluated the association between LGBT social group involvement and PrEP use. Study participation disclosure to parents and LGBT identity disclosure to anyone in a participant’s social network were associated with greater PrEP uptake. Study participation disclosure to partners was associated with higher probability of having protective PrEP drug concentrations compared [risk difference 0.15 95% CI (0.01, 0.30)]. For each additional type of LGBT organization a participant was involved in, the probability of PrEP uptake and having protective drug concentrations increased by 0.04 [95% CI (0.03, 0.06)] and 0.04 (95% CI (0.02, 0.07)] respectively. Overall, social context was associated with PrEP use in iPrEx OLE, and should be taken into consideration when designing future PrEP implementation programs.

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The iPrEx Open Label Extension was sponsored by the NIH (NIAID UO1 AI064002, RO1 AI062333, and RO1 AI118575) with study medication donated by Gilead Sciences.

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Corresponding authors

Correspondence to Megha L. Mehrotra or Robert M. Grant.

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Conflicts of interest

RM.G has received fees from and a research Grant from ViiV, a manufacturer of an investigational compound being investigated for use as PrEP. D.V.G is a member of an advisory board for Gilead Sciences. K.R.A. has a Gilead Sciences education Grant through the University of Michigan. All other authors: no reported conflicts.

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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.

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

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Mehrotra, M.L., Rivet Amico, K., McMahan, V. et al. The Role of Social Relationships in PrEP Uptake and Use Among Transgender Women and Men Who Have Sex with Men. AIDS Behav 22, 3673–3680 (2018).

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  • Pre-exposure prophylaxis
  • Social relationships
  • Disclosure
  • Social integration
  • Adherence