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AIDS and Behavior

, Volume 23, Issue 7, pp 1721–1736 | Cite as

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

  • Jingjing Li
  • Carla J. Berg
  • Michael R. Kramer
  • Regine Haardörfer
  • Maria Zlotorzynska
  • Travis H. SanchezEmail author
Original Paper

Abstract

This study explored the extent to which county- and individual-level factors were associated with awareness, willingness to use, and use of pre-exposure prophylaxis (PrEP) among US men who have sex with men (MSM). We conducted multilevel analyses using a sample of 8338 MSM residing in 1257 US counties drawn from the 2014–2015 American Men’s Internet Survey to examine these associations, with focuses on variation in PrEP outcomes across counties and proportion variation explained by county-level factors (HIV prevalence, racial composition, median household income, income inequality, health insurance coverage). Results showed that PrEP awareness varied moderately across counties (intraclass correlation coefficients [ICC] = 7.7%), willingness to use did not vary; however, the actual use varied substantially (ICC = 20.7%). Half of the variation in awareness and use was explained by county-level factors. Higher median household income was associated with greater likelihood of awareness and use. Higher income inequality was associated with greater likelihood of PrEP awareness. Findings can inform the development of multilevel interventions to address PrEP uptake among MSM and identify communities where structural intervention is most needed.

Keywords

HIV/AIDS Pre-exposure prophylaxis Men who have sex with men Uptake 

Notes

Acknowledgements

The authors would like to thank Hannah Cooper, Yongjiang Chen, Kevin Jefferson, Yenting Chen, Kathleen Krause, Catherine Prueitt, Nancy DeSousa Williams, and Blanche Greene Cramer for their valuable comments.

Funding

The work was supported by the National Institutes of Health (Emory Center for AIDS Research, P30AI050409) and the MAC AIDS Fund.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed as part of the American Men’s Internet Survey study involving human participants were conducted in accordance with the ethical standards of the Emory University Institutional Review Board (IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jingjing Li
    • 1
    • 3
  • Carla J. Berg
    • 1
  • Michael R. Kramer
    • 2
  • Regine Haardörfer
    • 1
  • Maria Zlotorzynska
    • 2
  • Travis H. Sanchez
    • 2
    Email author
  1. 1.Department of Behavioral Sciences and Health EducationEmory University School of Public HealthAtlantaUSA
  2. 2.Department of EpidemiologyEmory University School of Public HealthAtlantaUSA
  3. 3.Department of Epidemiology, School of Health SciencesWuhan UniversityWuhanPeople’s Republic of China

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