Skip to main content

Advertisement

SpringerLink
Log in

Differences in PrEP Awareness, Discussions with Healthcare Providers, and Use Among Men Who Have Sex with Men in the United States by Urbanicity and Region: A Cross-sectional Analysis

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention and is critical to the Ending the HIV Epidemic strategy. Most PrEP research has been conducted among urban populations; less is known about PrEP awareness, willingness to use, and actual use among rural and suburban populations. We examined these PrEP indicators by United States region and urbanicity among men who have sex with men who responded to the 2019 cycle of the American Men’s Internet Survey. Rural and suburban men were less likely than urban men to be aware of PrEP, to have discussed PrEP with a healthcare provider in the past 12 months, and to have ever used PrEP. Smaller differences were observed across regions. Notably, willingness to use PrEP was similar across region and urbanicity. Additional work will be needed to increase PrEP awareness and access among rural and suburban populations.

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

Access this article

Log in via an institution

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

Data Availability

Not applicable.

Code Availability

Not applicable.

References

  1. Centers for Disease Control and Prevention. HIV surveillance report, 2018 (updated). Vol. 31. 2020. https://www.cdc.gov/hiv/library/reports/hiv-surveillance. Accessed 14 June 2020.

  2. U.S. Department of Health and Human Services, Office of Infectious Disease and HIV/AIDS Policy. About ending the HIV epidemic: Plan for America. Priority jurisdictions: Phase I. 2020. https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictions/phase-one. Accessed 14 June 2020.

  3. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Virtal Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention. HIV surveillance in urban and nonurban areas. 2020. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-urban-nonurban-2018. Accessed 14 June 2020.

  4. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  Google Scholar 

  5. Grohskopf LA, Chillag KL, Gvetadze R, Liu AY, Thompson M, Mayer KH, et al. Randomized trial of clinical safety of daily oral tenofovir disoproxil fumarate among HIV-uninfected men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2013;64(1):79–86.

    Article  CAS  Google Scholar 

  6. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. 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. Lancet. 2016;387(10013):53–60.

    Article  Google Scholar 

  7. U.S. Department of Health & Human Services, U.S. Food and Drug Administration. Truvada for PrEP fact sheet: ensuring safe and proper use. 2020. https://fda.gov/media/83586/download. Accessed 14 June 2020.

  8. Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018;28(12):850-7.e9.

    Article  Google Scholar 

  9. Sullivan PS, Sanchez TH, Zlotorzynska M, Chandler CJ, Sineath R, Kahle E, et al. National trends in HIV pre-exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017. J Int AIDS Soc. 2020;23(3):e25461.

    Article  Google Scholar 

  10. Sullivan PS, Giler RM, Mouhanna F, Pembleton ES, Guest JL, Jones J, et al. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Ann Epidemiol. 2018;28(12):833–40.

    Article  Google Scholar 

  11. Hubach RD, Currin JM, Sanders CA, Durham AR, Kavanaugh KE, Wheeler DL, et al. Barriers to access and adoption of pre-exposure prophylaxis for the prevention of HIV among men who have sex with men (MSM) in a relatively rural state. AIDS Educ Prev. 2017;29(4):315–29.

    Article  Google Scholar 

  12. Owens C, Hubach RD, Williams D, Lester J, Reece M, Dodge B. Exploring the pre-exposure prophylaxis (PrEP) health care experiences among men who have sex with men (MSM) who live in rural areas of the Midwest. AIDS Educ Prev. 2020;32(1):51–66.

    Article  Google Scholar 

  13. Schnake-Mahl AS, Sommers BD. Health care in the suburbs: an analysis of suburban poverty and health care access. Health Aff (Millwood). 2017;36(10):1777–85.

    Article  Google Scholar 

  14. Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. Vital Health Stat 2. 2014;2(166):1–73.

    Google Scholar 

  15. Siegler AJ, Bratcher A, Weiss KM. Geographic access to preexposure prophylaxis clinics among men who have sex with men in the United States. Am J Public Health. 2019;109(9):1216–23.

    Article  Google Scholar 

  16. Sanchez T, Zlotorzynska M, Sineath C, Kahle E, Sullivan P. The annual American men’s internet survey of behaviors of men who have sex with men in the United States: 2014 key indicators report. JMIR Public Health Surveill. 2016;2(1):e23.

    Article  Google Scholar 

  17. Zlotorzynska M, Sullivan P, Sanchez T. The annual American men’s internet survey of behaviors of men who have sex with men in the United States: 2016 key indicators report. JMIR Public Health Surveill. 2019;5(1):e11313.

    Article  Google Scholar 

  18. United States Census Bureau. 2010 census regions and divisions of the United States. 2020. https://www.census.gov/geographies/reference-maps/2010/geo/2010-census-regions-and-divisions-of-the-united-states.html. Accessed 6 Mar 2020.

  19. Centers for Disease Control and Prevention. HIV infection risk, prevention, and testing behaviors among men who have sex with men-National HIV behavioral surveillance, 20 U.S. cities, 2014. HIV Surveillance Special Report 15. Available from: https://cdc.gov/hiv/library/reports/surveillance/#panel2. Accessed 6 Mar 2020.

  20. Patrick R, Forrest D, Cardenas G, Opoku J, Magnus M, Phillips G 2nd, et al. Awareness, willingness, and use of pre-exposure prophylaxis among men who have sex with men in Washington, DC and Miami-Dade County, FL: National HIV behavioral surveillance, 2011 and 2014. J Acquir Immune Defic Syndr. 2017;75(Suppl 3):S375-82.

    Article  Google Scholar 

  21. Kelley CF, Kahle E, Siegler A, Sanchez T, Del Rio C, Sullivan PS, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta. Georgia Clin Infect Dis. 2015;61(10):1590–7.

    Article  Google Scholar 

  22. Centers for Disease Control and Prevention: US Public Health Service: preexposure prophylaxis for the prevention of HIV infection in the United States-2017 update: a clinical practice guideline. 2020. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf. Accessed 14 June 2020.

  23. Muller CJ, MacLehose RF. Estimating predicted probabilities from logistic regression: different methods correspond to different target populations. Int J Epidemiol. 2014;43(3):962–70.

    Article  Google Scholar 

  24. VanderWeele TJ, Robins JM. Directed acyclic graphs, sufficient causes, and the properties of conditioning on a common effect. Am J Epidemiol. 2007;166(9):1096–104.

    Article  Google Scholar 

  25. Li J, Berg CJ, Kramer MR, Haardorfer R, Zlotorzynska M, Sanchez TH. An integrated examination of county- and individual-level factors in relation to HIV pre-exposure prophylaxis awareness, willingness to use, and uptake among men who have sex with men in the US. AIDS Behav. 2019;23(7):1721–36.

    Article  Google Scholar 

  26. Rosenkrantz DE, Black WW, Abreu RL, Aleshire ME, Fallin-Bennett K. Health and health care of rural sexual and gender minorities: a systematic review. Stigma Health. 2017;2(3):229–43.

    Article  Google Scholar 

  27. John SA, Rendina HJ, Grov C, Parsons JT. Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: an opportunity to address barriers to PrEP uptake and persistence. PLoS ONE. 2017;12(12):e0189794.

    Article  Google Scholar 

  28. Siegler A, Brock J, Kelley C, Ahlschlager L, Rolle C. Pilot test of a PrEP telemedicine system for young, black MSM in the rural US south. Seattle: CROI; 2019.

    Google Scholar 

  29. Refugio ON, Kimble MM, Silva CL, Lykens JE, Bannister C, Klausner JD. Brief report: PrEPTECH: a telehealth-based initiation program for HIV pre-exposure prophylaxis in young men of color who have sex with men. A pilot study of feasibility. J Acquir Immune Defic Syndr. 2019;80(1):40–5.

    Article  Google Scholar 

  30. Owens C, Hubach RD, Williams D, Voorheis E, Lester J, Reece M, et al. Facilitators and barriers of pre-exposure prophylaxis (PrEP) uptake among rural men who have sex with men living in the midwestern U.S. Arch Sex Behav. 2020. https://doi.org/10.1007/s10508-020-01654-6.

    Article  PubMed  Google Scholar 

  31. Rosengren AL, Lelutiu-Weinberger C, Woodhouse EW, Sandanapitchai P, Hightow-Weidman LB. A scoping review of HIV pre-exposure prophylaxis stigma and implications for stigma-reduction interventions for men and transwomen who have sex with men. AIDS Behav. 2021. https://doi.org/10.1007/s10461-021-03163-6.

    Article  PubMed  Google Scholar 

  32. Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “Truvada Whores.” Am J Public Health. 2015;105(10):1960–4.

    Article  Google Scholar 

  33. World Health Organization. WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV Infection. Module 1: Clinical. Geneva: World Health Organization; 2017. Accessed 14 June 2020.

  34. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321(9):844–5.

    Article  Google Scholar 

Download references

Funding

No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Shannon Rossiter, J. Danielle Sharpe, Sanjana Pampati, Travis Sanchez, Maria Zlotorzynska & Jeb Jones

Authors
  1. Shannon Rossiter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Danielle Sharpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sanjana Pampati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Travis Sanchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Zlotorzynska
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jeb Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SR, JDS, SP, and JJ. The first draft of the manuscript was written by SR and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shannon Rossiter.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study was approved by the Emory University Institutional Review Board.

Consent to Participate

Informed consent was obtained from all study participants in English.

Consent for Publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Tables 6, 78, 9, 10.

Table 6 Characteristics of participants of the 2019 cycle of the AMIS who are HIV-negative or have unknown HIV status (n = 9214) overall and by urbanicity
Full size table
Table 7 PrEP awareness among men who are HIV-negative or have unknown HIV status participating in the 2019 cycle of the AMIS by urbanicitya and US region
Full size table
Table 8 Willingness to use PrEP among men who are HIV-negative or have unknown HIV status participating in the 2019 cycle of the AMIS by urbanicitya and US region
Full size table
Table 9 Discussions about PrEP with a healthcare provider in the past 12 months among men who are HIV-negative or have unknown HIV status participating in the 2019 cycle of the AMIS by urbanicitya and US region
Full size table
Table 10 Ever use of PrEP among men who are HIV-negative or have unknown HIV status in the 2019 cycle of the AMIS by urbanicitya and US region
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rossiter, S., Sharpe, J.D., Pampati, S. et al. Differences in PrEP Awareness, Discussions with Healthcare Providers, and Use Among Men Who Have Sex with Men in the United States by Urbanicity and Region: A Cross-sectional Analysis. AIDS Behav 25, 4102–4114 (2021). https://doi.org/10.1007/s10461-021-03267-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03267-z

Keywords

Search

Navigation