Abstract
Assessing pre-exposure prophylaxis (PrEP) coverage and identifying reasons for disproportionate uptake among the varied social and cultural sub-groups of men who have sex with men (MSM) and transgender women who have sex with men (TWSM) are necessary precursors to setting attainable local PrEP. We report on findings of a cross-sectional survey among MSM/TWSM attending Gay pride events in Atlanta, Georgia, in 2018. Associations between PrEP awareness, uptake, and respondent characteristics were assessed using logistic regression. PrEP awareness did not differ by race, but current use was significantly lower among Blacks at substantial risk of HIV (p = .008). In multivariate analysis, clinician encounter in the past year was associated with awareness while age, income, drug use, sero-discordant sex, and multiple male partners were associated with current use. Among PrEP-naïve MSM/TWSM, the most common reasons for nonuse differed by race (poor knowledge of PrEP: Black—45% vs. non-Black—27%, p = .010, low perception of risk: Black—26% vs. non-Black—52%, p = .001). Key racial and socioeconomic disparities in active PrEP use and reasons for nonuse remain despite the recent increases in PrEP awareness and use among MSM/TWSM in Atlanta. Achieving overall improvement in uptake among all MSM/TWSM sub-groups will require tailoring PrEP educational messaging, optimizing communication modalities, expanding provider outreach, and identifying ways to defray costs for high-risk, underserved sub-groups in these populations.
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Acknowledgements
This work was assisted in part by a developmental grant from the NIH Center for AIDS Research (CFAR) at Emory University (P30AI050409). We also acknowledge all Sexual Health Promotion staff at Fulton County Board of Health, the #STOPHIVATL team, the Fulton County HIV/AIDS Advisory committee, the Georgia Department of Public Health and all Board of Health-affiliated community-based organizations for their spirited contributions toward ending the HIV epidemic in Fulton County and the City of Atlanta, Georgia.
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This work was assisted in part by a developmental Grant from the NIH Center for AIDS Research (CFAR) at Emory University (P30AI050409).
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Author ATC received a developmental grant from the NIH Center for AIDS Research (CFAR) at Emory University (P30AI050409) in August 2018 for the purpose of this study. All other authors have no conflict of interest to declare.
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The study protocol and survey instrument used in this study were reviewed and approved by the institutional review boards (IRB) of the Georgia Department of Public Health (Project #:180602) and Emory University.
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Survey data collection was completely anonymous, and the requirement for written informed consent was waived by both IRBs. Verbal consent was obtained from all individual participants included in the study.
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Onwubiko, U., Holland, D., Ajoku, S. et al. Using PrEP to #STOPHIVATL: Findings from a Cross-Sectional Survey Among Gay Men and Transgender Women Participating in Gay Pride Events in Atlanta, Georgia, 2018. Arch Sex Behav 49, 2193–2204 (2020). https://doi.org/10.1007/s10508-020-01711-0
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DOI: https://doi.org/10.1007/s10508-020-01711-0
Keywords
- Men who have sex with men (MSM)
- Transgender women who have sex with men (TWSM)
- PrEP
- Geographic hotspots
- Transgender
- Sexual orientation