Although pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV acquisition among adolescent cisgender men who have sex with men (cisMSM), various barriers faced by people of color, particularly within the southern region of the U.S., may lead to racial disparities in the utilization of PrEP. Few studies, however, have explored racial/ethnic differences in PrEP use by geographic setting among adolescent cisMSM. We conducted a cross-sectional analysis examining racial disparities in PrEP use among cisMSM ages 15–24 years in New Orleans, Louisiana, and Los Angeles, California recruited between May, 2017 and September, 2019. The odds of PrEP use among AA adolescents were considerably lower than White adolescents in New Orleans (OR (95% CI): 0.24 (0.10, 0.53)), although we did not find evidence of differences in Los Angeles. Our findings underscore the need for targeted interventions to promote PrEP use among adolescent MSM, particularly among AA adolescent cisMSM living in the southern region of U.S.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Centers for Disease Control and Prevention. HIV among youth|age|HIV by group|HIV/AIDS|CDC. 2019. https://www.cdc.gov/hiv/group/age/youth/index.html. Accessed 22 Oct 2019.
Siegler AJ, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28(12):841–9.
Finlayson T, et al. Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men—20 urban areas, 2014 and 2017. MMWR Morb Mortal Wkly Rep. 2019;68(27):597–603.
Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of black men who have sex with men: a critical literature review. Am J Public Health. 2006;96(6):1007–199.
Sullivan PS, et al. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS ONE. 2014;9(3):e90514.
Millett GA, et al. 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(9839):341–8.
Hamilton DT, et al. Potential impact of HIV preexposure prophylaxis among black and white adolescent sexual minority males. Am J Public Health. 2018;108:S284–S291291.
Pérez-Figueroa RE, Kapadia F, Barton SC, Eddy JA, Halkitis PN. Acceptability of PrEP uptake among racially/ethnically diverse young men who have sex with men: the p18 study. AIDS Educ Prev. 2015;27(2):112–25.
Bauermeister J, Meanley S, Pingel E, Soler J, Harper G. PrEP awareness and perceived barriers among single young men who have sex with men. Curr HIV Res. 2014;11(7):520–7.
García M, Harris AL. PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS ONE. 2017;12(9):e0184014.
Holloway IW, et al. Facilitators and barriers to pre-exposure prophylaxis willingness among young men who have sex with men who use geosocial networking applications in California. AIDS Patient Care STDS. 2017;31(12):517–27.
Kelley CF, et al. Applying a PrEP continuum of care for men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2015;61(10):1590–7.
Hosek SG, et al. An HIV preexposure prophylaxis demonstration project and safety study for young MSM. J Acquir Immune Defic Syndr. 2017;74(1):21–9.
Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson DM, Mayer KH. 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 Psychol Socio-Med Asp AIDS/HIV. 2017;29(11):1351–8.
Chetty R, et al. Income segregation and intergenerational mobility across colleges in the United States. Q J Econ. 2020. https://doi.org/10.1093/qje/qjaa005.
Siegler AJ, Bratcher A, Weiss KM, Mouhanna F, Ahlschlager L, Sullivan PS. Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States. Ann Epidemiol. 2018;28(12):858–64.
Kerr JC, et al. HIV-related stigma among african-american youth in the northeast and southeast US. AIDS Behav. 2014;18(6):1063–7.
Elopre L, Kudroff K, Westfall AO, Overton ET, Mugavero MJ. The right people, right places, and right practices: disparities in PrEP access among African American men, women and MSM in the deep south HHS Public access. J Acquir Immune Defic Syndr. 2017;35294(205):56–9.
Eaton LA, Matthews DD, Driffin DD, Bukowski L, Wilson PA, Stall RD. “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(5):505–16.
Kanny D, et al. Racial/ethnic disparities in HIV preexposure prophylaxis among men who have sex with men—23 urban areas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(37):801–6.
Whitfield THF, Parsons JT, Rendina HJ. Rates of pre-exposure prophylaxis use and discontinuation among a large U.S. national sample of sexual minority men and adolescents. Arch Sex Behav. 2020;49(1):103–12.
Office of Communications. NICHD, Item of interest: FDA approves PrEP therapy for adolescents at risk of HIV|NICHD. Bethesda: Eunice Kennedy Shriver National Institute of Child Health and Human Development; 2018.
Centers for Disease Control and Prevention. US Public Health Service: preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline. Atlanta: Centers for Disease Control and Prevention; 2018.
Vander Weele TJ, Robinson WR. On the causal interpretation of race in regressions adjusting for confounding and mediating variables. Epidemiology. 2014;25(4):473–84.
Strauss BB, et al. Exploring patterns of awareness and use of HIV pre-exposure prophylaxis among young men who have sex with men. AIDS Behav. 2017;21(5):1288–98.
AIDSVu. Mapping PrEP: first ever data on PrEP users across the U.S. 2019. https://aidsvu.org/prep/. Accessed 22 Oct 2019.
Logie CH, James L, Tharao W, Loutfy MR. HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med. 2011;8(11):e1001124.
Quinn K, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. ‘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 Behav. 2019;23(7):1951–63.
Irvin R, et al. A study of perceived racial discrimination in Black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing. AIDS Behav. 2014;18(7):1272–8.
Quinn K, Bowleg L, Dickson-Gomez J. ‘The fear of being Black plus the fear of being gay’: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019;232:86–93.
Mizuno Y, Borkowf C, Millett GA, Bingham T, Ayala G, Stueve A. Homophobia and racism experienced by latino men Who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS Behav. 2012;16(3):724–35.
Li MJ, Thing JP, Galvan FH, Gonzalez KD, Bluthenthal RN. Contextualising family microaggressions and strategies of resilience among young gay and bisexual men of Latino heritage. Cult Heal Sex. 2017;19(1):107–20.
Martinez O, et al. Integration of social, cultural, and biomedical strategies into an existing couple-based behavioral HIV/STI prevention intervention: voices of latino male couples. PLoS ONE. 2016;11(3):e0152361.
Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The impact of patient race on clinical decisions related to prescribing HIV pre-exposure prophylaxis (PrEP): assumptions about sexual risk compensation and implications for access. AIDS Behav. 2014;18(2):226–40.
Semega JL, Fontenot KR, Kollar MA. Income and poverty in the United States: 2016 current population reports. Washington, DC: U.S. Government Printing Office; 2017.
Halkitis PN, Jaiswal J, Griffin-Tomas M, Krause KD, D’Avanzo P, Kapadia F. Beliefs about the end of AIDS, concerns about PrEP functionality, and perceptions of HIV risk as drivers of PrEP use in urban sexual minority men: the P18 cohort study. AIDS Behav. 2018;22(11):3705–17.
Brooks RA, Landovitz RJ, Regan R, Lee SJ, Allen VC. Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS. 2015;26(14):1040–8.
Wood SM, Lee S, Barg FK, Castillo M, Dowshen N. Young transgender women’s attitudes toward HIV pre-exposure prophylaxis. J Adolesc Health. 2017;60(5):549–55.
Hannaford A, et al. The use of online posts to identify barriers to and facilitators of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: a comparison to a systematic review of the peer-reviewed literature. AIDS Behav. 2018;22(4):1080–95.
Ojikutu BO, et al. Facilitators and barriers to pre-exposure prophylaxis (PrEP) use among black individuals in the United States: results from the national survey on HIV in the Black Community (NSHBC). AIDS Behav. 2018;22(11):3576–87.
Hubach RD, et al. Barriers to access and adoption of pre-exposure prophylaxis for the prevention of HIV among men who have sex with men (MSM) in a relatively rural state. AIDS Educ Prev. 2017;29(4):315–29.
Brooks RA, Allen VC, Regan R, Mutchler MG, Cervantes-Tadeo R, Lee SJ. HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS. 2018;29(4):375–81.
Carnevale C, et al. Adolescent preexposure prophylaxis administration: an education curriculum for health care providers. J Pediatr Health Care. 2019;33(3):288–95.
Blakemore S-J, Robbins TW. Decision-making in the adolescent brain. Nat Neurosci. 2012;15(9):1184–91.
Touger R, Wood BR. A review of telehealth innovations for HIV pre-exposure prophylaxis (PrEP). Curr HIV/AIDS Rep. 2019;16(1):113–9.
California Department of Public Health. PrEP assistance program (PrEP-AP) benefits. 2018. https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_adap_benefits_prepAP.aspx. Accessed: 07 May 2020.
Calabrese SK, et al. A closer look at racism and heterosexism in medical students’ clinical decision-making related to HIV pre-exposure prophylaxis (PrEP): implications for PrEP education. AIDS Behav. 2018;22(4):1122–38.
Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7–8):1060–75.
Epner DE, Baile WF. Patient-centered care: the key to cultural competence. Ann Oncol. 2012;23(Supplement 3):33–44.
Allen E, Gordon A, Krakower D, Hsu K. HIV preexposure prophylaxis for adolescents and young adults. Curr Opin Pediatr. 2017;29(4):399–406.
The following members of the ATN CARES Team made contributions to this manuscript: Mary Jane Rotheram-Borus, Jeff Klausner, Isa Fernandez, Sue Ellen Abdalian, and Yvonne Bryson, W. Scott Comulada, Ellen Almirol, Cameron Goldbeck, Wilson Ramos, Panteha Razvan. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U19HD089886). This study also received support from the National Institute of Mental Health through the Center for HIV Identification, Prevention, and Treatment Services (P30MH058107), the UCLA Center for AIDS Research (P30AI028697), and the UCLA Clinical and Translational Science Institute (UL1TR001881). We would like to thank the study participants for their time commitment in participating in the study and helping advance the field of HIV prevention and treatment.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Saleska, J.L., Lee, S., Leibowitz, A. et al. A Tale of Two Cities: Exploring the Role of Race/Ethnicity and Geographic Setting on PrEP Use Among Adolescent Cisgender MSM. AIDS Behav (2020). https://doi.org/10.1007/s10461-020-02951-w
- Pre-exposure prophylaxis (PrEP)
- Men who have sex with men (MSM)