Elevated HIV Prevalence and Correlates of PrEP Use Among a Community Sample of Black Men who Have Sex with Men
Lisa A. Eaton
Derrick D. Matthews
Leigh A. Bukowski
Mackey R. Friedman
Cristian J. Chandler
Darren L. Whitfield
Background: The HIV epidemic among Black men who have sex with men (BMSM) demands urgent public health attention. Pre-Exposure Prophylaxis (PrEP) is a highly efficacious option for preventing HIV, but characteristics of PrEP use among community samples of BMSM are not well-understood.
Methods: A serial cross-sectional survey assessment (N=4,184 BMSM reporting HIV negative/unsure status) and HIV testing were conducted at Black Gay Pride events in six US cities in 2014, 2015, 2016, and 2017.
Results: HIV prevalence was higher among BMSM self-reporting current PrEP use (1 out of 3 participants) than BMSM not self-reporting current PrEP use (1 out of 5 participants) (32.3%, N=103/319 vs. 20.0%, N=639/3,193, aOR=1.68, 95%CI=1.31-2.15). BMSM reporting current PrEP use (N=380) were more likely to report having a greater number of male sex partners (aOR=1.02, 95%CI=1.01-1.03), a STI diagnosis (aOR=2.44, 95%CI=1.88-3.16), and stimulant drug use (aOR=2.05, 95%CI=1.21-3.47) when compared to BMSM not reporting current PrEPuse (N=3,804). PrEP use increased from 4.7% (2014) to 15.5% (2017) (aOR=1.19, 95%CI=1.13-1.25). Among PrEP users, inability to afford health care coverage was associated with testing HIV positive (aOR=2.10, 95%CI=1.24-3.56).
Conclusion: The high prevalence of HIV infection among BMSM reporting PrEP use is concerning. It does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, STI treatment, and medication adherence counseling. Further research to understand barriers to fully effective PrEP are needed in order to guide operational and behavioral interventions that close the gap on incident infection.