Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis (PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men

Abstract

In the United States, rates of HIV infection are highest among black men who have sex with men (BMSM). Preexposure prophylaxis (PrEP) is a highly effective form of HIV prevention, but the uptake of this strategy has been slow since FDA approval in 2012, and it is unknown whether information about PrEP is reaching BMSM. Four hundred and thirty-six BMSM in Atlanta, GA were surveyed from January 2012 (6 months prior to PrEP approval) to March 2014 (20 months after approval). Analyses revealed no association between date of survey assessment and awareness of PrEP (20.5% were aware of PrEP before approval and 23.4% were aware after approval; OR = 0.99 [0.98-1.02], p = 0.952). In a multivariate model, BMSM unaware of PrEP reported lower rates of HIV testing knowledge, fewer experiences with HIV testing, and higher rates of transactional sex than BMSM who were aware of PrEP. Our findings suggest that there is limited understanding of PrEP and that there is considerable groundwork that needs to be achieved in order to reap the full benefits of PrEP. The current findings call attention to the need to both prioritize and better understand how to strengthen the bridge between medical advances and community uptake.

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men

“…Although PrEP for HIV prevention was approved by the US FDA in 2012, uptake of PrEP among individuals in-need has been limited [6–8]. In order for PrEP to have a population-level impact on incident HIV infections, scale-up efforts must be prioritized and barriers to implementation need to be addressed.…”

Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale‐up and implementation

“…However, other biomedical prevention techniques such as pre‐exposure prophylaxis (PrEP) have had limited uptake over time despite both strong public health endorsements and relatively high initial acceptability 15, 16, 17, 18, 19, 20. Some barriers to PrEP uptake that have been noted, such as inaccurate knowledge and risk perception 21 as well as community norms about condom use 22, 23, may also important to consider as part of the implementation and scale‐up of TasP messaging.…”

Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

“…First, awareness of PrEP was the step most strongly associated with incidence reduction for BMSM in our model, due to the marginally declining conditional probabilities for the subsequent steps. There has been a wide range of findings on the awareness and willingness of BMSM to use PrEP [13,14], related to lack of knowledge about PrEP and perceived stigma related to its use [15,49,50]. Second, access to PrEP-related healthcare is .…”

“…Open-label PrEP studies and clinical cohorts have consistently highlighted specific challenges in reaching BMSM, supporting protective levels of PrEP adherence, and retaining them in PrEP care [11][12][13][14][15][16][17][18][19][20][21]. These racial gaps may limit the prevention benefits of PrEP for BMSM.…”