Abstract
Healthcare providers whom people see regularly (e.g., primary care providers [PCPs]) are likely to interact with individuals at risk of human immunodeficiency virus (HIV). However, most PCPs report never prescribing pre-exposure prophylaxis (PrEP), a medication that prevents HIV infection. This study examined the association between having a regular healthcare provider and PrEP use among men who have sex with men (MSM). We analyzed health survey data from Black (n = 151) and White (n = 113) MSM in Atlanta, GA using log binomial regressions. Among Black MSM, the proportion who used PrEP was nearly three times higher for those with a regular provider compared to those without one (aPR 2.58; 95% CI: 0.96, 6.93). Conversely, the proportion of White MSM who used PrEP was slightly lower among those with a regular provider (aPR 0.67; 95% CI: 0.36, 1.27). Findings suggest having a regular provider may be more strongly associated with PrEP among Black MSM.
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References
AAMC. (2019). Diversity in Medicine: Facts and Figures 2019. Retrieved December 2, 2021 from https://www.aamc.org/data-reports/workforce/interactive-data/figure-18-percentage-all-active-physicians-race/ethnicity-2018
AHRQ. (2011). Primary Care Workforce Facts and Stats No. 1. Retrieved December 2, 2021 from https://www.ahrq.gov/sites/default/files/publications/files/pcwork1.pdf
AIDSVu. (2021). PrEP Services Across the U.S. Retrieved November 30, 2021 from https://aidsvu.org/services/#/prep
America’s HIV Epidemic Analysis Dashboard. (2021). Ending the HIV Epidemic: A Plan for America. PrEP Coverage. Retrieved from March 17, 2021 https://ahead.hiv.gov/indicators?active=PrEP%20coverage
Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., Lama, J. R., Guanira, J. V., McMahan, V., Bushman, L. R., Casapía, M., Montoya-Herrera, O., Veloso, V. G., iPrEx Study Team. (2012). Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med, 4, 151ra125. https://doi.org/10.1126/scitranslmed.3004006
Blackstock, O. J., Addison, D. N., Brennan, J. S., & Alao, O. A. (2012). Trust in primary care providers and antiretroviral adherence in an urban HIV clinic. Journal of Health Care for the Poor and Underserved, 23, 88–98. https://doi.org/10.1353/hpu.2012.0006
Blackstock, O. J., Moore, B. A., Berkenblit, G. V., Calabrese, S. K., Cunningham, C. O., Fiellin, D. A., Patel, V. V., Phillips, K. A., Tetrault, J. M., Shah, M., & Edelman, E. J. (2017). A cross-sectional online survey of HIV pre-exposure prophylaxis adoption among primary care physicians. Journal of General Internal Medicine, 32, 62–70. https://doi.org/10.1007/s11606-016-3903-z
Braksmajer, A., Fedor, T. M., Chen, S. R., Corales, R., Holt, S., Valenti, W., & McMahon, J. M. (2018). Willingness to take PrEP for HIV prevention: the combined effects of race/ethnicity and provider trust. AIDS Education and Prevention, 30, 1–12. https://doi.org/10.1521/aeap.2018.30.1.1
CDC. (2019). Issue Brief: HIV in the Southern United States. Retrieved September 6, 2020 from https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf
CDC. (2020a). HIV Surveillance Report, 2018 (Updated). vol. 31. Retrieved August 19, 2020a from http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html
CDC. (2020b). NHBS Round 5 (2017–2019). Retrieved July 19, 2020b from https://www.cdc.gov/hiv/pdf/statistics/systems/nhbs/NHBS_CRQ_R5_HET5.pdf
CDC: US Public Health Service. (2018). Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline. Retrieved August 19, 2020 from https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf
Cahill, S., Taylor, S. W., Elsesser, S. A., Mena, L., Hickson, D., & Mayer, K. H. (2017). Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care, 29, 1351–1358. https://doi.org/10.1080/09540121.2017.1300633
Choopanya, K., Martin, M., Suntharasamai, P., Sangkum, U., Mock, P. A., Leethochawalit, M., Chiamwongpaet, S., Kitisin, P., Natrujirote, P., Kittimunkong, S., Chuachoowong, R., Bangkok Tenofovir Study Group. (2013). Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet, 381, 2083–2090. https://doi.org/10.1016/S0140-6736(13)61127-7
Chu, B. A., Castellanos, E. R., Gonzales, M. M., & Gaither, T. W. (2020). Social determinants of self-reported pre-exposure prophylaxis use among a national sample of US men who have sex with men. Sexually Transmitted Infections, 96, 368–374. https://doi.org/10.1136/sextrans-2019-054177
Clement, M. E., Seidelman, J., Wu, J., Alexis, K., McGee, K., Okeke, N. L., Samsa, G., & McKellar, M. (2018). An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S. AIDS Care, 30, 650–655. https://doi.org/10.1080/09540121.2017.1384534
D’Angelo, A. B., Lopez-Rios, J., Flynn, A. W. P., Holloway, I. W., Pantalone, D. W., & Grov, C. (2021). Insurance- and medical provider-related barriers and facilitators to staying on PrEP: Results from a qualitative study. Translational Behavioral Medicine, 11, 573–581. https://doi.org/10.1093/tbm/ibz191
Eaton, L. A., Driffin, D. D., Kegler, C., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2015). The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. American Journal of Public Health, 105, e75-82. https://doi.org/10.2105/AJPH.2014.302322
Finlayson, T., Cha, S., Xia, M., Trujillo, L., Denson, D., Prejean, J., Kanny, D., Wejnert, C., Abrego, M., Al-Tayyib, A., & Anderson, B. (2019). Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men-20 urban areas, 2014 and 2017. Morbidity and Mortality Weekly Report, 68, 597–603. https://doi.org/10.15585/mmwr.mm6827a1
Georgia Department of Public Health. (2020). Healthcare Workforce Data. Retrieved December 4, 2021 from https://healthcareworkforce.georgia.gov/health-care-workforce-data
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., Goicochea, P., Casapía, M., Guanira-Carranza, J. V., Ramirez-Cardich, M. E., Montoya-Herrera, O., iPrEx Study Team. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599. https://doi.org/10.1056/NEJMoa1011205
HHS. (2012). FDA approves first drug for reducing the risk of sexually acquired HIV infection. Retrieved March 17, 2021 from https://www.hiv.gov/blog/fda-approves-first-drug-for-reducing-the-risk-of-sexually-acquired-hiv-infection
Jones, J., Dominguez, K., Stephenson, R., Stekler, J. D., Castel, A. D., Mena, L. A., Jenness, S. M., Siegler, A. J., & Sullivan, P. S. (2020). A theoretically based mobile app to increase pre-exposure prophylaxis uptake among men who have sex with men: Protocol for a randomized controlled trial. JMIR Research Protocol, 9, e16231. https://doi.org/10.2196/16231
Kanny, D., Jeffries, W. L., IV., Chapin-Bardales, J., Denning, P., Cha, S., Finlayson, T., Wejnert, C., Abrego, M., Al-Tayyib, A., Anderson, B., & Barak, N. (2019). Racial/Ethnic Disparities in HIV Preexposure Prophylaxis Among Men Who Have Sex with Men - 23 Urban Areas, 2017. Morbidity and Mortality Weekly Report, 68, 801–806. https://doi.org/10.15585/mmwr.mm6837a2
Krakower, D., Ware, N., Mitty, J. A., Maloney, K., & Mayer, K. H. (2014). HIV providers’ perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: A qualitative study. AIDS and Behavior, 18, 1712–1721. https://doi.org/10.1007/s10461-014-0839-3
Marks, S. J., Merchant, R. C., Clark, M. A., Liu, T., Rosenberger, J. G., Bauermeister, J., & Mayer, K. H. (2017). Potential healthcare insurance and provider barriers to pre-exposure prophylaxis utilization among young men who have sex with men. AIDS Patient Care and STDs, 31, 470–478. https://doi.org/10.1089/apc.2017.0171
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., & Remis, R. S. (2012). 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, 380, 341–348. https://doi.org/10.1016/S0140-6736(12)60899-X
Mimiaga, M. J., Reisner, S. L., Bland, S., Skeer, M., Cranston, K., Isenberg, D., Vega, B. A., & Mayer, K. H. (2009). Health system and personal barriers resulting in decreased utilization of HIV and STD testing services among at-risk black men who have sex with men in Massachusetts. AIDS Patient Care and STDs, 23, 825–835. https://doi.org/10.1089/apc.2009.0086
NCHS. (2014). State Variability in Supply of Office-based Primary Care Providers: United States, 2012. Retrieved February 3, 2021 from https://www.cdc.gov/nchs/data/databriefs/db151.pdf
National Library of Medicine. (2018). Pre-exposure Prophylaxis (PrEP) at Home (PrEP@Home). Retrieved February 10, 2021 from https://clinicaltrials.gov/ct2/show/NCT03569813
Onwubiko, U., Holland, D., Ajoku, S., Taylor, J., Childs, A., Wilson, D., & Chamberlain, A. T. (2020). Using PrEP to #STOPHIVATL: Findings from a cross-sectional survey among gay men and transgender women participating in gay pride events in Atlanta, Georgia, 2018. Archives of Sexual Behavior, 49, 2193–2204. https://doi.org/10.1007/s10508-020-01711-0
Oster, A. M., Wiegand, R. E., Sionean, C., Miles, I. J., Thomas, P. E., Melendez-Morales, L., Le, B. C., & Millett, G. A. (2011). Understanding disparities in HIV infection between black and white MSM in the United States. AIDS, 25, 1103–1112. https://doi.org/10.1097/QAD.0b013e3283471efa
Patel, R. R., Mena, L., Nunn, A., McBride, T., Harrison, L. C., Oldenburg, C. E., Liu, J., Mayer, K. H., & Chan, P. A. (2017). Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention. PLoS ONE, 12, e0178737. https://doi.org/10.1371/journal.pone.0178737
Petroll, A. E., DiFranceisco, W., McAuliffe, T. L., Seal, D. W., Kelly, J. A., & Pinkerton, S. D. (2009). HIV testing rates, testing locations, and healthcare utilization among urban African-American men. Journal of Urban Health, 86, 119–131. https://doi.org/10.1007/s11524-008-9339-y
Petroll, A. E., & Mitchell, J. W. (2015). Health insurance and disclosure of same-sex sexual behaviors among gay and bisexual men in same-sex relationships. LGBT Health, 2, 48–54. https://doi.org/10.1089/lgbt.2013.0050
Petroll, A. E., & Mosack, K. E. (2011). Physician awareness of sexual orientation and preventive health recommendations to men who have sex with men. Sexually Transmitted Diseases, 38, 63–67. https://doi.org/10.1097/OLQ.0b013e3181ebd50f
Petroll, A. E., Walsh, J. L., Owczarzak, J. L., McAuliffe, T. L., Bogart, L. M., & Kelly, J. A. (2017). PrEP awareness, familiarity, comfort, and prescribing experience among us primary care providers and HIV specialists. AIDS and Behavior, 21, 1256–1267. https://doi.org/10.1007/s10461-016-1625-1
Quinn, K., Dickson-Gomez, J., Zarwell, M., Pearson, B., & Lewis, M. (2019). “A Gay Man and a Doctor are Just like, a Recipe for Destruction”: How racism and homonegativity in healthcare settings influence PrEP uptake among young black MSM. AIDS and Behavior, 23, 1951–1963. https://doi.org/10.1007/s10461-018-2375-z
Rolle, C. P., Onwubiko, U., Jo, J., Sheth, A. N., Kelley, C. F., & Holland, D. P. (2019). PrEP implementation and persistence in a county health department setting in Atlanta, GA. AIDS and Behavior, 23, 296–303. https://doi.org/10.1007/s10461-019-02654-x
Sohn, H. (2017). Racial and ethnic disparities in health insurance coverage: Dynamics of gaining and losing coverage over the life-course. Population Research and Policy Review, 36, 181–201. https://doi.org/10.1007/s11113-016-9416-y
Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis, misunderstanding and mistrust: Relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99, 879–885.
Sullivan, P. S., Rosenberg, E. S., Sanchez, T. H., Kelley, C. F., Luisi, N., Cooper, H. L., Diclemente, R. J., Wingood, G. M., Frew, P. M., Salazar, L. F., & Del Rio, C. (2015). Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: A prospective observational cohort study. Annals of Epidemiology, 25, 445–454. https://doi.org/10.1016/j.annepidem.2015.03.006
Sullivan, P. S., Taussig, J., Valentine-Graves, M., Luisi, N., Del Rio, C., Guest, J. L., Jones, J., Millett, G., Rosenberg, E. S., Stephenson, R., & Kelley, C. (2021). Disparities in care outcomes in atlanta between black and white men who have sex with men living with HIV: Protocol for a prospective cohort study (Engage[men]t). JMIR Research Protocol, 10, e21985. https://doi.org/10.2196/21985
Trost, S. L., Onwubiko, U. N., Wilson, D. B., Holland, D. P., & Chamberlain, A. T. (2020). Health care-seeking behaviors and perceptions of provider-initiated discussion of pre-exposure prophylaxis among PrEP-naive HIV-negative men who have sex with men in Atlanta, Georgia. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofaa165
Wilkin, T. (2015). Clinical practice. Primary care for men who have sex with men. The New England Journal of Medicine, 373, 854–862. https://doi.org/10.1056/NEJMcp1401303
Acknowledgements
Contributors: We would like to thank the participants who completed our survey for their time and participation as well as the Fulton County Board of Health and the Emory University Center for AIDS Research [P30AI050409] for their support. Funders: This work was supported by the Emory University Center for AIDS Research [P30AI050409]. Prior Presentations: This work was presented at the 2021 Council for State and Territorial Epidemiologist Annual Conference on June 14, 2021.
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This work was supported by the Emory University Center for AIDS Research [P30AI050409].
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The study design and survey were developed and implemented by Udodirim Onwubiko, David Holland, and Allison Chamberlain. The analyses were conducted by Eleanor Garlow. The first draft of the manuscript was written by Eleanor Garlow. All authors reviewed and commented on the draft manuscript and approved the final manuscript.
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The authors (E.W.G., U.N.O., D.P.H., and A.T.C.) have no relevant financial or non-financial interests to disclose with respect to the research, authorship, and publication of this article (direct or indirectly related to the submitted work for publication).
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The methodology for this study and the survey were approved by the Institutional Review Boards at the Georgia Department of Public Health and Emory University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
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This study was approved by the relevant IRB for human subjects research and all participants provided informed consent. Participants who completed the survey in-person provided their verbal consent and participants who completed the survey online provided their consent online.
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Garlow, E.W., Onwubiko, U.N., Holland, D.P. et al. Association between having a regular healthcare provider and pre-exposure prophylaxis use among men who have sex with men: a cross-sectional survey. J Behav Med 45, 428–437 (2022). https://doi.org/10.1007/s10865-022-00308-3
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DOI: https://doi.org/10.1007/s10865-022-00308-3