June 17, 2016
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Despite low uptake, more than half of MSM willing to take PrEP

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Although less than 4% among men who have sex with men use pre-exposure prophylaxis, or PrEP, more than 60% indicate they would be willing to take the preventive treatment, according to recent data.

In addition, black and white MSM showed similar interest in PrEP use; however, reported uptake was higher among white MSM than among black MSM, Brooke E. Hoots, PhD, MSPH, epidemiologist in the Division of HIV/AIDS prevention at the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and colleagues said.

Brooke E. Hoots

“PrEP use was not common among MSM … in 2014, although a racial disparity exists between black and white MSM with respect to PrEP use in our sample,” they wrote. “This disparity may be attributable to racial differences in health care access rather than a lack of interest in PrEP since both black and white MSM reported high willingness to take PrEP.”

Hoots and colleagues examined survey data collected from adult, HIV-negative MSM in 20 U.S. cities through the CDC’s National HIV Behavioral Surveillance System (NHBS). They conducted interviews to determine respondents’ self-reported willingness to take PrEP, PrEP use within the previous 12 months and whether respondents had any of the CDC’s recommended indications for PrEP prescription. The researchers analyzed these data to describe the responses in terms of demographic characteristics and reported sexual behaviors.

Of the 6,483 MSM in the analysis, 61% reported willingness to take PrEP. Black and white MSM were equally interested in PrEP, although younger MSM, those reporting a bacterial STD within the previous year, and those reporting casual male sex partners within the previous year were more often willing.

Despite these findings, PrEP use within the previous year was reported by 3.7% of respondents. Use varied significantly among demographic and behavioral groups, with white MSM twice as likely to report PrEP use than black MSM. PrEP use also was more frequent among those with higher education and current health insurance, and among participants reporting a recent bacterial STD or risky sexual behaviors. Respondents from San Francisco and Washington, D.C., reported PrEP use more often than those from other cities included in the NHBS, which the researchers hypothesized could be the result of these cities’ participation in recent open-label PrEP delivery projects.

According to CDC guidelines, 57% of participants would have at least one indication for PrEP, and white and Hispanic/Latino MSM were more likely to have an indication than black MSM. Because blacks’ increased risk for HIV infection is associated with social factors such as poverty or racial discrimination, the researchers wrote, current CDC guidelines on PrEP indications that primarily focus on risky sexual behaviors may induce a disparity in HIV prevention care.

“To prevent racial disparities in PrEP use, it will be important for clinicians to consider epidemiologic context in addition to risk behaviors when considering PrEP indications,” they wrote. “This will increase the likelihood that PrEP is offered to those at highest risk of HIV acquisition and that the greatest impact on HIV incidence is achieved.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.