Low Awareness of PrEP in Young Black MSM

Veronica Hackethal, MD

November 16, 2015

A study in the south side of Chicago, Illinois, has shown low awareness of preexposure prophylaxis (PrEP) for HIV among high-risk young black men who have sex with men (YBMSM). The study also identified sociodemographic, health, behavioral, and social factors linked to low PrEP awareness in this group.

"While PrEP is promising, this population-based cohort study illustrates that real-world PrEP use by those with the highest HIV incidence faces major implementation challenges that require purposeful and sustained engagement with black communities inclusive of their health care providers," write Aditya Khanna, PhD, from the University of Chicago, and colleagues.

They report their finding in an article published online November 16 in JAMA Internal Medicine.

YBMSM represent the one of the few groups in the United States in which HIV incidence is still increasing. One contributing factor may be that effective clinic-based HIV prevention programs have failed to reach this population. In 2012, the US Food and Drug Administration approved PrEP for HIV. The regimen includes daily oral tenofovir disoproxil fumarate and emtricitabine and is estimated to be more than 90% effective. Low awareness and use of PrEP, however, may play a role in HIV disparities, the authors note.

The study, called uConnect, took place on the south side of Chicago, which has a large black community and is an area with a high prevalence of HIV. Between June 2013 and July 2014, researchers recruited 622 participants who self-identified as African American or Black, were born male, were between 16 and 29 years old, and had had oral or anal sex with a man within the past 24 months.

Participants had a median age of 22.7 years. Approximately 39% had a high school or general education development diploma, and 79.3% had an annual income of less than $20,000. Among HIV-negative (PrEP-eligible) participants, just 48% had some type of health insurance.

At baseline, 40.5% of participants reported PrEP awareness, and this percentage remained about the same during the recruitment period. Only 12.1% knew other people who had used PrEP. About 72.1% of participants were HIV-negative, although only 3.6% had used PrEP.

Factors significantly associated with PrEP awareness included having a primary care provider, participating in an HIV prevention program or research study, having had an ano-rectal sexually transmitted infection test, and membership in the House and Ball community, a national organization of "houses" made up mostly of YBMSM and transgender women that has existed in Chicago since the 1930s.

Meeting with an HIV outreach worker within 12 months of study recruitment was also significantly linked to PrEP awareness (adjusted odds ratio, 2.02; 95% confidence interval, 1.29 - 3.16).

"Ongoing work should include scientific assessment of strategies to mobilize networks of YBMSM around PrEP as part of a comprehensive health care program," the authors conclude. "Concomitantly, efforts to mitigate the structural barriers that prevent PrEP uptake among YBMSM may greatly improve the public health effect potential of this promising HIV prevention intervention."

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online November 16, 2015.

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