Skip to main content

Advertisement

SpringerLink
Log in

Factors Associated with Being PrEP-Naïve Among a U.S. National Cohort of Former-PrEP and PrEP-Naïve Participants Meeting Objective Criteria for PrEP Care

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

There is an urgent need to increase uptake and persistence in HIV pre-exposure prophylaxis (PrEP) in PrEP-eligible candidates. Little is known about the similarities and differences between groups of PrEP-naïve and former users, an important consideration for future interventions. We explored factors associated with being PrEP-naïve in a U.S. national cohort of naïve and former-PrEP users, all of whom met objective criteria for PrEP care at enrollment. Data were derived from the Together 5000 cohort study, an Internet-based U.S. national cohort of cisgender and trans men and trans women who have sex with men. Participants were recruited via ads on men-for-men geosocial networking apps. All participants were not on PrEP at the time of enrollment. We conducted bivariate analysis to explore differences between the two groups and used multivariable logistic regression to assess factors associated with being PrEP-naïve. Of the 6283 participants, 5383 (85.7%) were PrEP-naïve and 900 (14.3%) were former-PrEP users. There were significant differences between PrEP-naïve and former-PrEP users across multiple demographic variables, in addition to PrEP-related and psychosocial variables. Factors associated with being PrEP-naïve included younger age, sexual identity other than gay/queer, lower perception of candidacy for PrEP care, less willingness to take PrEP, lower access to PrEP care, and individual-level barriers such as health- and provider-related concerns. Programs and policies designed to address uptake and persistence of PrEP should be aware of these differences. Providing care in non-traditional LGBTQ-care settings, home-based PrEP interventions, and provision by healthcare providers other than physicians could improve uptake. Future research should investigate mechanisms that can improve uptake and persistence in communities in need of PrEP.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Bradley, H., Hall, H. I., Wolitski, R. J., Van Handel, M. M., Stone, A. E., LaFlam, M., … Patel, R. (2014). Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. Morbidity and Mortality Weekly Report, 63(47), 1113–1117.

    PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  Google Scholar 

  • CDC. (2017). HIV Surveillance Report, 2016. Retrieved May 5, 2020 from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.

  • CDC. (2019). HIV Surveillance Report, 2017. Retrieved May 5, 2020 from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html.

  • Chan, P. A., Mena, L., Patel, R., Oldenburg, C. E., Beauchamps, L., Perez-Brumer, A. G., … Nunn, A. (2016). Retention in care outcomes for HIV pre-exposure prophylaxis implementation programmes among men who have sex with men in three US cities. Journal of the International AIDS Society, 19(1), 20903. https://doi.org/10.7448/IAS.19.1.20903.

    Article  PubMed  PubMed Central  Google Scholar 

  • Collier, K. L., Colarossi, L. G., & Sanders, K. (2017). Raising awareness of pre-exposure prophylaxis (PrEP) among women in New York City: Community and provider perspectives. Journal of Health Communication, 22(3), 183–189.

    Article  Google Scholar 

  • Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor–Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82.

    Article  Google Scholar 

  • Defechereux, P. A., Mehrotra, M., Liu, A. Y., McMahan, V. M., Glidden, D. V., Mayer, K. H., … Fernandez, T. (2016). Depression and oral FTC/TDF pre-exposure prophylaxis (PrEP) among men and transgender women who have sex with men (MSM/TGW). AIDS and Behavior, 20(7), 1478–1488.

    Article  Google Scholar 

  • Denning, P. H., DiNenno, E. A., & Wiegand, R. E. (2011). Characteristics associated with HIV infection among heterosexuals in urban areas with high AIDS prevalence-24 cities, United States, 2006-2007. Journal of the American Medical Association, 306(12), 1320–1322.

    Google Scholar 

  • 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(2), 177–186.

    Article  Google Scholar 

  • Golub, S. A. (2018). PrEP stigma: Implicit and explicit drivers of disparity. Current HIV/AIDS Reports, 15, 190–197.

    Article  Google Scholar 

  • Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A., & Lelutiu-Weinberger, C. L. (2013). From efficacy to effectiveness: Facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care and STDs, 27(4), 248–254.

    Article  Google Scholar 

  • Golub, S. A., & Myers, J. E. (2019). Next-wave HIV pre-exposure prophylaxis implementation for gay and bisexual men. AIDS Patient Care and STDs, 33, 253–261.

    Article  Google Scholar 

  • Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., … Ramirez-Cardich, M. E. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587–2599.

    Article  Google Scholar 

  • Grov, C., Westmoreland, D. A., Carneiro, P. B., Stief, M., MacCrate, C., Mirzayi, C., … Nash, D. (2019). Recruiting vulnerable populations to participate in HIV prevention research: Findings from the Together 5000 cohort study. Annals of Epidemiology, 35, 4–11. https://doi.org/10.1016/j.annepidem.2019.05.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grov, C., Whitfield, T. H., Rendina, H. J., Ventuneac, A., & Parsons, J. T. (2015). Willingness to take PrEP and potential for risk compensation among highly sexually active gay and bisexual men. AIDS and Behavior, 19(12), 2234–2244.

    Article  Google Scholar 

  • Gupta, G. R., Parkhurst, J. O., Ogden, J. A., Aggleton, P., & Mahal, A. (2008). Structural approaches to HIV prevention. The Lancet, 372(9640), 764–775.

    Article  Google Scholar 

  • Herek, G. M., Cogan, J. C., Gillis, J. R., & Glunt, E. K. (1998). Correlates of internalized homophobia in a community sample of lesbians and gay men. Journal of the Gay and Lesbian Medical Association, 2, 17–26.

    Google Scholar 

  • Holloway, I., Dougherty, R., Gildner, J., Beougher, S. C., Pulsipher, C., Montoya, J. A., … Leibowitz, A. (2017). PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications. Journal of Acquired Immune Deficiency Syndromes, 74(1), 15–20.

    Article  Google Scholar 

  • Huang, Y.-L. A.,, Zhu, W., Smith, D. K., Harris, N., & Hoover, K. W. (2018). HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. Morbidity and Mortality Weekly Report, 67(41), 1147–1150.

    Article  Google Scholar 

  • John, S. A., Rendina, H. J., Grov, C., & Parsons, J. T. (2017). Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: An opportunity to address barriers to PrEP uptake and persistence. PLoS ONE, 12(12), e0189794. https://doi.org/10.1371/journal.pone.0189794

    Article  PubMed  PubMed Central  Google Scholar 

  • Kelley, C. F., Kahle, E., Siegler, A., Sanchez, T., del Rio, C., Sullivan, P. S., & Rosenberg, E. S. (2015). Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clinical Infectious Diseases, 61(10), 1590–1597.

    Article  Google Scholar 

  • King, M. F., & Bruner, G. C. (2000). Social desirability bias: A neglected aspect of validity testing. Psychology & Marketing, 17(2), 79–103.

    Article  Google Scholar 

  • Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics, 50(6), 613–621.

    PubMed  Google Scholar 

  • Liu, A. Y., Cohen, S. E., Vittinghoff, E., Anderson, P. L., Doblecki-Lewis, S., Bacon, O., … Amico, K. R. (2016). Preexposure prophylaxis for HIV infection integrated with municipal-and community-based sexual health services. JAMA Internal Medicine, 176(1), 75–84.

    Article  Google Scholar 

  • McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., … Schembri, G. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet, 387(10013), 53–60.

    Article  Google Scholar 

  • Nash, D., Stief, M., MacCrate, C., Mirzayi, C., Patel, V. V., Hoover, D., … Westmoreland, D. A. (2019). A web-based study of HIV prevention in the era of pre-exposure prophylaxis among vulnerable HIV-negative gay and bisexual men, transmen, and transwomen who have sex with men: Protocol for an observational cohort study. Journal of Medical Internet Research-Research Protocols, 8(9), e13715. https://doi.org/10.2196/13715.

  • O’Byrne, P., MacPherson, P., Orser, L., Jacob, J. D., & Holmes, D. (2019). PrEP-RN: Clinical considerations and protocols for nurse-led PrEP. Journal of the Association of Nurses in AIDS Care, 30(3), 301–311.

    Article  Google Scholar 

  • 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: The motivational PrEP cascade. Journal of Acquired Immune Deficiency Syndromes, 74(3), 285–292.

    Article  Google Scholar 

  • Parsons, J. T., Rendina, H. J., Whitfield, T. H., & Grov, C. (2016). Familiarity with and preferences for oral and long-acting injectable HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the US. AIDS and Behavior, 20(7), 1390–1399.

    Article  Google Scholar 

  • Rendina, H. J., Whitfield, T. H., Grov, C., Starks, T. J., & Parsons, J. T. (2017). Distinguishing hypothetical willingness from behavioral intentions to initiate HIV pre-exposure prophylaxis (PrEP): Findings from a large cohort of gay and bisexual men in the US. Social Science and Medicine, 172, 115–123.

    Article  Google Scholar 

  • Rusie, L. K., Orengo, C., Burrell, D., Ramachandran, A., Houlberg, M., Keglovitz, K., … Schneider, J. A. (2018). Preexposure prophylaxis initiation and retention in care over 5 years, 2012–2017: Are quarterly visits too much? Clinical Infectious Diseases, 67(2), 283–287.

    Article  Google Scholar 

  • Ryan, K., Lewis, J., Sanchez, D., Anderson, B., & Mercier, R.-C. (2018). The next step in PrEP: Evaluating outcomes of a pharmacist-run HIV pre-exposure prophylaxis (PrEP) clinic. Paper presented at the Open Forum Infectious Diseases, San Diego, CA.

  • Scott, H. M., Spinelli, M., Vittinghoff, E., Morehead-Gee, A., Hirozawa, A., James, C., … Buchbinder, S. (2019). Racial/ethnic and HIV risk category disparities in PrEP discontinuation among patients in publicly-funded primary care clinics. AIDS, 33, 2189–2195.

  • Sevelius, J. M., Keatley, J., Calma, N., & Arnold, E. (2016). ‘I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Global Public Health, 11(7–8), 1060–1075.

    Article  Google Scholar 

  • Siegler, A. J., Mayer, K. H., Liu, A. Y., Patel, R. R., Ahlschlager, L. M., Kraft, C. S., … Sullivan, P. S. (2019). Developing and assessing the feasibility of a home-based preexposure prophylaxis monitoring and support program. Clinical Infectious Diseases, 68(3), 501–504.

    Article  Google Scholar 

  • Smith, D., Van Handel, M., & Grey, J. (2018). By race/ethnicity, blacks have highest number needing PrEP in the United States, 2015. Paper presented at the Conference on Retroviruses and Opportunistic Infections, Boston, MA.

  • Smith, D. K., Van Handel, M., Wolitski, R. J., Stryker, J. E., Hall, H. I., Prejean, J., … Valleroy, L. A. (2015). Vital signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. Morbidity and Mortality Weekly Report, 64(46), 1291–1295.

    Article  Google Scholar 

  • Touger, R., & Wood, B. R. (2019). A review of telehealth innovations for HIV pre-exposure prophylaxis (PrEP). Current HIV/AIDS Reports, 16(1), 113–119.

    Article  Google Scholar 

  • Volk, J. E., Marcus, J. L., Phengrasamy, T., Blechinger, D., Nguyen, D. P., Follansbee, S., & Hare, C. B. (2015). No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clinical Infectious Diseases, 61(10), 1601–1603.

    Article  Google Scholar 

Download references

Funding

Funding was provided by National Institute of Allergy and Infectious Diseases (Grant No. UG3 AI 133675), National Institute of Mental Health (Grant No. K23MH102118).

Author information

Authors and Affiliations

  1. Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St., 7th Floor Mailroom, New York, NY, 10027, USA

    Pedro B. Carneiro & Christian Grov

  2. CUNY Institute for Implementation Science in Population Health, New York, NY, USA

    Drew A. Westmoreland & Christian Grov

  3. Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York, NY, USA

    Viraj V. Patel

Authors
  1. Pedro B. Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Drew A. Westmoreland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Viraj V. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Grov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Grov.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All research methods and process were approved and overseen by the CUNY Institutional Review Board.

Informed Consent

Participants signed an informed consent form in each stage of our cohort study, and consent could be withdrawn at any time.

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

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carneiro, P.B., Westmoreland, D.A., Patel, V.V. et al. Factors Associated with Being PrEP-Naïve Among a U.S. National Cohort of Former-PrEP and PrEP-Naïve Participants Meeting Objective Criteria for PrEP Care. Arch Sex Behav 50, 1793–1803 (2021). https://doi.org/10.1007/s10508-020-01791-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-020-01791-y

Keywords

Search

Navigation