Pre-Exposure Prophylaxis (PrEP) Uptake among Black Men Who Have Sex with Men (BMSM) in the Southern U.S

Oluwafemi Adeagbo, Sayward Harrison, Shan Qiao, Xiaoming Li, Oluwafemi Adeagbo, Sayward Harrison, Shan Qiao, Xiaoming Li

Abstract

Black men who have sex with men (BMSM) living in the United States (U.S.) South are disproportionately affected by HIV and experience significant disparities in HIV incidence, access to HIV care, and prevention across ages and socio-economic statuses. The aim of this commentary is to critically review current literature on the state of PrEP use among BMSM in the U.S. South, including identifying barriers and facilitators to PrEP use in order to inform intervention development. Extant literature shows that despite the documented benefits of PrEP as an effective HIV-prevention method, its uptake among BMSM is limited across the U.S. South. Common barriers to PrEP uptake included stigma, homophobia, mistrust of healthcare systems, negative attitudes from healthcare providers, access and transportation issues, poverty, and misinformation about PrEP. These barriers are likely to have been further exacerbated by the COVID-19 pandemic. Limited access to PrEP and other HIV-prevention programs, such as HIV testing, post-exposure prophylaxis (PEP), and condoms for BMSM are likely increase HIV incidence in this community. Moreover, the rapid expansion of telehealth services during the COVID-19 period may offer increased opportunity to scale-up PrEP through telehealth interventions, especially if in-person services remain limited due to pandemic precautions. Given the intersectional barriers that limit the access and uptake of PrEP among BMSM, we suggest that tailored programs or interventions that seek to address PrEP disparities among Southern BMSM should adopt intersectional and interdisciplinary approaches to better understand the complex challenges of scaling up PrEP. More studies are needed to investigate the impact of COVID-19 on HIV-prevention services among BMSM and to understand how to co-develop-with the BMSM community and healthcare providers-culturally acceptable interventions to reduce the identified challenges using intersectional and interdisciplinary approaches.

Keywords: BMSM; COVID-19; HIV; PrEP; Southern states; United States.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

References

    1. Fauci A.S., Redfield R.R., Sigounas G., Weahkee M.D., Giroir B.P. Ending the HIV epidemic: A plan for the United States. JAMA. 2019;321:844–845. doi: 10.1001/jama.2019.1343.
    1. Qiao S., Li Z., Weissman S., Li X., Olatosi B., Davis C., Mansaray A.B. Disparity in hiv service interruption in the outbreak of covid-19 in south carolina. AIDS Behav. 2021;25:49–57. doi: 10.1007/s10461-020-03013-x.
    1. Rawlings M.K., Parham-Hopson D. HIV in US Communities of Color. Springer; Cham, Switzerland: 2021. HIV in the South; pp. 135–146.
    1. CDC . Estimated HIV Incidence and Prevalence in the United States, 2014–2018. Centers for Disease Control and Prevention; Atlanta, GA, USA: 2020. HIV Surveillance Supplemental Report.
    1. Smith D.K., Rawlings M.K. HIV in US Communities of Color. Springer; Cham, Switzerland: 2021. PrEP and the Black Community; pp. 51–64.
    1. Rouffiac A.E., Whiteley L., Brown L., Mena L., Craker L., Healy M., Haubrick K. A Mobile Intervention to Improve Uptake of Pre-Exposure Prophylaxis for Southern Black Men Who Have Sex with Men: Protocol for Intervention Development and Pilot Randomized Controlled Trial. JMIR Res. Protoc. 2020;9:e15781. doi: 10.2196/15781.
    1. Mouhanna F., Castel A.D., Sullivan P.S., Kuo I., Hoffman H.J., Siegler A.J., Jones J.S., Giler R.M., McGuinness P., Kramer M.R. Small-area spatial-temporal changes in pre-exposure prophylaxis (PrEP) use in the general population and among men who have sex with men in the United States between 2012 and 2018. Ann. Epidemiol. 2020;49:1–7. doi: 10.1016/j.annepidem.2020.07.001.
    1. Smith D.K., 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;28:850–857.e9. doi: 10.1016/j.annepidem.2018.05.003.
    1. Millett G.A., Peterson J.L., Flores S.A., Hart T.A., Jeffries W.L., 4th, Wilson P.A., Rourke S.B., Heilig C.M., Elford J., Fenton K.A. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: A meta-analysis. Lancet. 2012;380:341–348. doi: 10.1016/S0140-6736(12)60899-X.
    1. CDC . HIV Surveillance Report, 2019. Centers for Disease Control and Prevention; Atlanta, GA, USA: 2021. pp. 1–123.
    1. Hess K.L., Hu X., Lansky A., Mermin J., Hall H.I. Lifetime risk of a diagnosis of HIV infection in the United States. Ann. Epidemiol. 2017;27:238–243. doi: 10.1016/j.annepidem.2017.02.003.
    1. Koblin B.A., Mayer K.H., Eshleman S.H., Wang L., Mannheimer S., Del Rio C., Shoptaw S., Magnus M., Buchbinder S., Wilton L. Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS ONE. 2013;8:e70413. doi: 10.1371/journal.pone.0070413.
    1. Rosenberg E.S., Grey J.A., Sanchez T.H., Sullivan P.S. Rates of prevalent HIV infection, prevalent diagnoses, and new diagnoses among men who have sex with men in US states, metropolitan statistical areas, and counties, 2012–2013. JMIR Public Health Surveill. 2016;2:e22. doi: 10.2196/publichealth.5684.
    1. Harawa T., Bempong G.A., Fields S., Leibowitz A., Lee D., Meyer P., Mills T., Moore L., Shoptaw S. Engaging Black Men Who Have Sex with Men (BMSM) in Los Angeles in HIV PreExposure Prophylaxis (PrEP) California HIV/AIDS Policy Centers; Los Angeles, CA, USA: 2016.
    1. Harawa N.T., Schrode K.M., McWells C., Weiss R.E., Hilliard C.L., Bluthenthal R.N. Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex with Men (BMSM) AIDS Educ. Prev. 2020;32:311–324. doi: 10.1521/aeap.2020.32.4.311.
    1. Dunville R., Harper C., Johns M.M., Viox M.H., Avripas S., Fordyce E., Stern M., Schlissel A., Carpenter R., Michaels S. Awareness and willingness to use biomedical prevention strategies for HIV among sexual and gender minority youth: Results from a national survey. J. Adolesc. Health. 2021;68:199–206. doi: 10.1016/j.jadohealth.2020.05.032.
    1. Sullivan P.S., Sanchez T.H., Zlotorzynska M., Chandler C.J., Sineath R.C., Kahle E., Tregear S. 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:e25461. doi: 10.1002/jia2.25461.
    1. Sullivan P.S., Giler R.M., Mouhanna F., Pembleton E.S., Guest J.L., Jones J., Castel A.D., Yeung H., Kramer M., McCallister S. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Ann. Epidemiol. 2018;28:833–840. doi: 10.1016/j.annepidem.2018.06.009.
    1. Eaton L.A., Matthews D.D., Driffin D.D., Bukowski L., Wilson P.A., Stall R.D., The POWER Study Team A Multi-US City Assessment of Awareness and Uptake of Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Black Men and Transgender Women Who Have Sex with Men. Prev. Sci. 2017;18:505–516. doi: 10.1007/s11121-017-0756-6.
    1. Li J., Berg C.J., Kramer M.R., Haardörfer R., Zlotorzynska M., Sanchez T.H. 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;23:1721–1736. doi: 10.1007/s10461-018-2334-8.
    1. Centers for Disease Control and Prevention . HIV Infection Risk, Prevention, and Testing Behaviors Among Men Who Have Sex with Men: National HIV Behavioral Surveillance 23 U.S. Cities, 2017. Centers for Disease Control and Prevention; Atlanta, GA, USA: 2019.
    1. Sanders R.A., Morgan A., Oidtman J., Qian I., Celentano D., Beyrer C. A Medical Care Missed Opportunity: Pre-exposure Prophylaxis & Young Black men who have sex with men (YBMSM) J. Adolesc. Health. 2016;59:725–728.
    1. Kota K.K., Mansergh G., Stephenson R., Hirshfield S., Sullivan P. Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities. AIDS Patient Care STDs. 2021;35:158–166. doi: 10.1089/apc.2020.0261.
    1. Weiss K., Bratcher A., Sullivan P., Siegler A. Geographic access to PrEP clinics among US MSM: Documenting PrEP deserts; Proceedings of the Conference on Retroviruses and Opportunistic Infections (CROI); Boston, MA, USA. 4–7 March 2018; Abstract 1006.
    1. Smit P.J., Brady M., Carter M., Fernandes R., Lamore L., Meulbroek M., Ohayon M., Platteau T., Rehberg P., Rockstroh J.K. HIV-related stigma within communities of gay men: A literature review. AIDS Care. 2012;24:405–412. doi: 10.1080/09540121.2011.613910.
    1. Auerbach J.D., Hoppe T.A. Beyond “getting drugs into bodies”: Social science perspectives on pre-exposure prophylaxis for HIV. J. Int. AIDS Soc. 2015;18:19983. doi: 10.7448/IAS.18.4.19983.
    1. Frye V., Nandi V., Egan J., Cerda M., Greene E., Van Tieu H., Ompad D.C., Hoover D.R., Lucy D., Baez E. Sexual orientation-and race-based discrimination and sexual HIV risk behavior among urban MSM. AIDS Behav. 2015;19:257–269. doi: 10.1007/s10461-014-0937-2.
    1. Garofalo R., Mustanski B., Johnson A., Emerson E. Exploring factors that underlie racial/ethnic disparities in HIV risk among young men who have sex with men. J. Urban Health. 2010;87:318–323. doi: 10.1007/s11524-009-9430-z.
    1. Bauermeister J.A., Meanley S., Pingel E., Soler J.H., Harper G.W. PrEP awareness and perceived barriers among single young men who have sex with men in the United States. Curr. HIV Res. 2013;11:520–527. doi: 10.2174/1570162X12666140129100411.
    1. DeNavas-Walt C., Proctor B.D., Smith J.C. Income, Poverty, and Health Insurance Coverage in the United States: 2012. US Census Bureau; Suitland, MD, USA: 2013. pp. 60–245. Current Population Reports.
    1. Mullins T.L.K., Lally M., Zimet G., Kahn J.A., The Adolescent Medicine Trials Network for HIV/AIDS Interventions Clinician attitudes toward CDC interim pre-exposure prophylaxis (PrEP) guidance and operationalizing PrEP for adolescents. AIDS Patient Care STDs. 2015;29:193–203. doi: 10.1089/apc.2014.0273.
    1. Henny K.D., Duke C.C., Geter A., Gaul Z., Frazier C., Peterson J., Buchacz K., Sutton M.Y. HIV-related training and correlates of knowledge, HIV screening and prescribing of nPEP and PrEP among primary care providers in Southeast United States, 2017. AIDS Behav. 2019;23:2926–2935. doi: 10.1007/s10461-019-02545-1.
    1. Smith D.K., Chang M.-H., Duffus W.A., Okoye S., Weissman S. Missed opportunities to prescribe preexposure prophylaxis in South Carolina, 2013–2016. Clin. Infect. Dis. 2019;68:37–42. doi: 10.1093/cid/ciy441.
    1. Sanchez T.H., Zlotorzynska M., Rai M., Baral S.D. Characterizing the impact of COVID-19 on men who have sex with men across the United States in April, 2020. AIDS Behav. 2020;24:2024–2032. doi: 10.1007/s10461-020-02894-2.
    1. Santos G.-M., Ackerman B., Rao A., Wallach S., Ayala G., Lamontage E., Garner A., Holloway I.W., Arreola S., Silenzio V. Economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response on a global sample of cisgender gay men and other men who have sex with men. AIDS Behav. 2021;25:311–321. doi: 10.1007/s10461-020-02969-0.
    1. Torres T.S., Marins L.M.S., Veloso V.G., Grinsztejn B., Luz P.M. How heterogeneous are MSM from Brazilian cities? An analysis of sexual behavior and perceived risk and a description of trends in awareness and willingness to use pre-exposure prophylaxis. BMC Infect. Dis. 2019;19:1067. doi: 10.1186/s12879-019-4704-x.
    1. Wilton L. HIV in US Communities of Color. Springer; Cham, Switzerland: 2021. HIV Prevention, Care, and Treatment Among Black Men Who Have Sex with Men (MSM) pp. 65–79.
    1. Wheeler D.P., Fields S.D., Beauchamp G., Chen Y.Q., Emel L.M., Hightow-Weidman L., Hucks-Ortiz C., Kuo I., Lucas J., Magnus M., et al. Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: Results from the HPTN 073 study. J. Int. AIDS Soc. 2019;22:e25223. doi: 10.1002/jia2.25223.
    1. Bowleg L. Towards a critical health equity research stance: Why epistemology and methodology matter more than qualitative methods. Health Educ. Behav. 2017;44:677–684. doi: 10.1177/1090198117728760.
    1. English D., Carter J.A., Bowleg L., Malebranche D.J., Talan A.J., Rendina H.J. Intersectional social control: The roles of incarceration and police discrimination in psychological and HIV-related outcomes for Black sexual minority men. Soc. Sci. Med. 2020;258:113121. doi: 10.1016/j.socscimed.2020.113121.
    1. Mullings L., Schulz A.J., editors. Gender, Race, Class, & Health: Intersectional Approaches. Jossey-Bass/Wiley; Francisco, CA, USA: 2006. Intersectionality and Health: An Introduction; pp. 3–17.
    1. Wheeler D.P., Lucas J., Wilton L., Nelson L.E., Hucks-Ortiz C., Watson C.C., Hutchinson C., Mayer K.H., Kuo I., Magnus M. Building effective multilevel HIV prevention partnerships with Black men who have sex with men: Experience from HPTN 073, a pre-exposure prophylaxis study in three US cities. J. Int. AIDS Soc. 2018;21:e25180. doi: 10.1002/jia2.25180.
    1. Levy M.E., Wilton L., Phillips G., Glick S.N., Kuo I., Brewer R.A., Elliott A., Watson C., Magnus M. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18:972–996. doi: 10.1007/s10461-014-0719-x.

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