Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men

Abstract

Background

Limited access to healthcare has been associated with limited uptake of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM). This descriptive analysis examined, in a near universal healthcare setting, differences between MSM reporting using versus not using PrEP in the past 12 months.

Method

Data come from the 2017 Boston sample of the National HIV Behavioral Surveillance (NHBS) system, containing a venue-based and time-spaced sample of 530 MSM. The analysis used descriptive frequencies and tests of bivariate associations by PrEP use using Fisher’s exact test.

Results

Five hundred four respondents had data necessary to determine if PrEP was indicated, and 233 (43.9%) had an indication for PrEP. Of these 233 participants, 117 (50.2%) reported using PrEP in the past 12 months. Not being out, in terms of disclosing one’s sexual orientation to a healthcare provider, lack of health insurance, limited access to healthcare, and history of incarceration were all significantly associated with not using PrEP in the past 12 months. Race/ethnicity was not significantly associated with PrEP use in the past 12 months.

Conclusions

In the setting of Massachusetts healthcare expansion and reform, and in a sample somewhat uncharacteristic of the population of individuals experiencing difficulties accessing PrEP, structural and demographic factors remain potent barriers to PrEP uptake. Targeted PrEP expansion efforts in Massachusetts may focus on identifying vulnerable subgroups of MSM (e.g., underinsured or criminal justice system-involved MSM) and delivering evidence-based interventions to reduce stigma and promote disclosure of same-sex behavior in healthcare settings.

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Funding

This publication was made possible by Grant Numbers T32 AI007433 and 5P30AI060354-15 from the National Institute of Allergy and Infectious Diseases.

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Correspondence to Calvin Fitch.

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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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Ken Mayer has received unrestricted research grants from Gilead Sciences. The other authors have no conflicts of interest to declare.

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Fitch, C., Foley, J., Klevens, M. et al. Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men. Int.J. Behav. Med. (2021). https://doi.org/10.1007/s12529-021-09986-w

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Keywords

  • Pre-exposure prophylaxis (PrEP)
  • MSM
  • HIV
  • Socioeconomic factors
  • Prevention