Skip to main content

Advertisement

Log in

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

  • Published:
Prevention Science Aims and scope Submit manuscript

Abstract

The HIV epidemic among Black men and transgender women who have sex with men (BMTW) demands an urgent public health response. HIV point prevalence among this population ranges from 25 to 43%—a rate far exceeding any other group. Pre-exposure prophylaxis (PrEP) for HIV prevention is a very promising prevention tool; however, its full potential to slow the epidemic has yet to be realized. For the current study, random time-location sampling at Black Gay Pride Events was used to collect data from N = 1274 BMTW, from five US cities, reporting HIV-negative/unknown status. In-field HIV testing was also provided to participants. Participants were assessed on awareness and use of PrEP, health care factors, HIV testing history, psychosocial variables, and sex behaviors. About one third of participants were aware of PrEP (39%), and a small percentage of participants were users of PrEP (4.6%). In multivariable analyses, being in a relationship, testing for HIV in the past 6 months, and others being aware of one’s sexuality were positively associated with PrEP awareness. Higher levels of internalized homophobia and greater numbers of female sex partners were positively associated with PrEP use, while education and condom use were negatively associated. Based on study findings, messaging and uptake of PrEP needs greater expansion and requires novel approaches for scale-up. Improving linkage to HIV testing services is likely critical for engaging BMTW with PrEP. The potential for PrEP to slow the HIV epidemic is high; however, we must strengthen efforts to ensure universal availability and uptake.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Al-Tayyib, A. A., Thrun, M. W., Haukoos, J. S., & Walls, N. E. (2014). Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men in Denver, Colorado. AIDS & Behavior, 18, 340–347.

    Article  Google Scholar 

  • Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.

    CAS  PubMed  Google Scholar 

  • Auerbach, J. D., & Hoppe, T. A. (2015). Beyond “getting drugs into bodies”: Social science perspectives on pre-exposure prophylaxis for HIV. Journal of the International AIDS Society, 18, 19983.

    Article  PubMed  PubMed Central  Google Scholar 

  • AVAC.org. (2015). Global Advocacy for HIV Prevention. http://www.avac.org/prep/track-research. Accessed January 13, 2015.

  • Bauermeister, J. A., Meanley, S., Pingel, E., Soler, J. H., & Harper, G. W. (2013). PrEP awareness and perceived barriers among single young men who have sex with men. Current HIV/AIDS Research, 11, 520–527.

    Article  CAS  Google Scholar 

  • Brooks, R., & Allen, V. (2014). Acceptability of HIV pre-exposure prophylaxis (PrEP) at varying levels of effectiveness among low SES black gay and bisexual men in Los Angeles: Implications for PrEP dissemination. 9th International Conference on HIV Treatment and Prevention Adherence. IAPAC, Miami, FL.

  • Brooks, R. A., Kaplan, R. L., Lieber, E., Landovitz, R. J., Lee, S. J., & Leibowitz, A. A. (2011). Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care, 23, 1136–1145.

    Article  PubMed  PubMed Central  Google Scholar 

  • Burress, J. (2014). ‘Truvada whore’ stigma endures among doctors and LGBTs. The Advocate. http://www.advocate.com/health/2014/08/11/truvada-whore-stigma-endures-among-doctors-and-lgbts.

  • Bursac, Z., Gauss, C. H., Williams, D. K., & Hosmer, D. W. (2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine, 3, 17.

    Article  PubMed  PubMed Central  Google Scholar 

  • Caceres, C. F., O’Reilly, K. R., Mayer, K. H., & Baggaley, R. (2015). PrEP implementation: Moving from trials to policy and practice. Journal of the International AIDS Society, 18, 20222.

    PubMed  PubMed Central  Google Scholar 

  • Carrillo, J. E., Carrillo, V. A., Perez, H. R., Salas-Lopez, D., Natale-Pereira, A., & Byron, A. T. (2011). Defining and targeting health care access barriers. Journal of Health Care for the Poor and Underserved, 22, 562–575.

    Article  PubMed  Google Scholar 

  • Cohen, S. E., Liu, A. Y., Bernstein, K. T., & Philip, S. (2013). Preparing for HIV pre-exposure prophylaxis: Lessons learned from post-exposure prophylaxis. American Journal of Preventive Medicine, 44, S80–85.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, S. E., Vittinghoff, E., Bacon, O., Doblecki-Lewis, S., Postle, B.S., Feaster, D…Liu, A.Y. (2015). High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: Baseline data from the US PrEP demonstration project. Journal of Acquired Immune Deficiency Syndrome, 68, 439–448.

  • Cremin, I., Alsallaq, R., Dybul, M., Piot, P., Garnett, G., & Hallett, T. B. (2013). The new role of antiretrovirals in combination HIV prevention: A mathematical modelling analysis. AIDS, 27, 447–458.

    Article  PubMed  Google Scholar 

  • Duran, D. (2012). Truvada whores? Huffpost Gay Voices. http://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html. Accessed January 3, 2015.

  • Dutta, M. J. (2013). Disseminating HIV pre-exposure prophylaxis information in underserved communities. American Journal of Preventive Medicine, 44, S133–136.

    Article  PubMed  Google Scholar 

  • Eaton, L. A., Driffin, D. D., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2014). Psychosocial factors related to willingness to use pre-exposure prophylaxis for HIV prevention among Black men who have sex with men attending a community event. Sexual Health, 11, 244–251.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eaton, L. A., Driffin, D. D., Bauermeister, J., Smith, H., & Conway-Washington, C. (2015). Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, Black men who have sex with men. AIDS Patient Care & STDS, 29, 423–9.

    Article  Google Scholar 

  • Gamarel, K. E., & Golub, S. A. (2015). Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Annals of Behavioral Medicine, 49, 177–186.

    Article  PubMed  PubMed Central  Google Scholar 

  • Glazek, C. (2014). Why I am a Truvada whole. OUT. http://www.out.com/entertainment/popnography/2014/05/20/why-i-am-truvada-whore. Accessed January 3, 2015.

  • Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L…iPrex Study Team. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363, 2587–2599.

  • Hammer, G. P., Kellogg, T. A., McFarland, W. C., Wong, E., Louie, B., Williams, I…Klausner, J. D. (2003). Low incidence and prevalence of hepatitis C virus infection among sexually active non-intravenous drug-using adults, San Francisco, 1997–2000. Sexually Transmitted Diseases, 30, 919–924.

  • Herbst, J. H., Jacobs, E. D., Finlayson, T. J., Mckleroy, V. S., Crepaz, N., & HIV/AIDS Prevention Research Synthesis Team. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS & Behavior, 12, 1–17.

    Article  Google Scholar 

  • Hurt, C. B., Eron, J. J., Jr., & Cohen, M. S. (2011). Pre-exposure prophylaxis and antiretroviral resistance: HIV prevention at a cost? Clinical Infectious Diseases, 53, 1265–1270.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kalichman, S. C. (1998). Post-exposure prophylaxis for HIV infection in gay and bisexual men. Implications for the future of HIV prevention. American Journal of Preventive Medicine, 15, 120–127.

    Article  CAS  PubMed  Google Scholar 

  • Katz, M. H., & Gerberding, J. L. (1997). Postexposure treatment of people exposed to the human immunodeficiency virus through sexual contact or injection-drug use. New England Journal of Medicine, 336, 1097–1100.

    Article  CAS  PubMed  Google Scholar 

  • Kirby, T., & Thornber-Dunwell, M. (2014). Uptake of PrEP for HIV slow among MSM. Lancet, 383, 399–400.

    Article  PubMed  Google Scholar 

  • Koblin, B. A., Mayer, K. H., Eshleman, S. H., Wang, L., Mannheimer, S., del Rio, C….HPTN 061 Protocol Team. (2013). 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, 8, e70413.

  • Krakower, D. S., Mimiaga, M. J., Rosenberger, J. G., Novak, D. S., Mitty, J. A., White, J. M., & Mayer, K. H. (2012). Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an Internet social networking site. PLoS One, 7, e33119.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kurtz, S. P., Buttram, M. E., & Surratt, H. L. (2014). Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA. AIDS Care, 26, 411–415.

    Article  PubMed  Google Scholar 

  • Liu, A. Y., Kittredge, P. V., Vittinghoff, E., Raymond, H. F., Ahrens, K., Matheson, T …Buchbinder, S. P. (2008). Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men. Journal of Acquired Immune Deficiency Syndrome, 47, 241–247.

  • Liu, A., Cohen, S., Follansbee, S., Cohan, D., Weber, S., Sachdev, D., & Buchbinder, S. (2014). Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Medicine, 11, e1001613.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lurie, P., Miller, S., Hecht, F., Chesney, M., & Lo, B. (1998). Postexposure prophylaxis after nonoccupational HIV exposure: clinical, ethical, and policy considerations. Journal of the American Medical Association, 280, 1769–1773.

    Article  CAS  PubMed  Google Scholar 

  • Matthews, D. D., Herrick, A. L., Coulter, R. W., Friedman, M. R., Mills, T. C., Eaton, L. A…POWER Study Team (2015). Running backwards: Consequences of current HIV incidence rates for the next generation of Black MSM in the United States. AIDS & Behavior, 20:7–16.

  • Mayer, K. H., & Krakower, D. S. (2015). Editorial commentary: Scaling up antiretroviral preexposure prophylaxis: moving from trials to implementation. Clinical Infectious Diseases, 61, 1598–600.

    Article  PubMed  PubMed Central  Google Scholar 

  • McCormack, S., & Dunn, D. (2015). Pragmatic open-label randomised trial of preexposure prophylaxis: The PROUD Study. Conference on Retroviruses and Opportunistic Infections. AIS-USA, Seattle, Washington.

  • Mehta, S. A., Silvera, R., Bernstein, K., Holzman, R. S., Aberg, J. A., & Daskalakis, D. C. (2011). Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City. Sexually Transmitted Infections, 87, 344–348.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.

    Article  CAS  PubMed  Google Scholar 

  • Molina, J., Capitant, C., Spire, B., Pialoux, G., Chidiac, C., Charreau, I…Delfraissy, J. F. (2015). On demand PrEP with oral TDF-FTC in MSM: Results of the ANRS Ipergay Trial. Conference on Retroviruses and Opportunistic Infections. AIS-USA, Seattle, Washington.

  • Mutchler, M. G., McDavitt, B., Ghani, M. A., Nogg, K., Winder, T. J., & Soto, J. K. (2015). Getting PrEPared for HIV prevention navigation: Young Black gay men talk about HIV prevention in the biomedical era. AIDS Patient Care & STDS, 29, 490–502.

    Article  Google Scholar 

  • Norton, W. E., Larson, R. S., & Dearing, J. W. (2013). Primary care and public health partnerships for implementing pre-exposure prophylaxis. American Journal of Preventive Medicine, 44, S77–79.

    Article  PubMed  Google Scholar 

  • PRePWatch. 2016. http://www.prepwatch.org/. Accessed January 25, 2016.

  • Purcell, D. W., Johnson, C. H., Lansky, A., Prejean, J., Stein, R., Denning, P…Crepaz, N. (2012). Estimating the population size of men who have sex with men in the United States to obtain HIV and syphilis rates. Open AIDS Journal, 6, 98–107.

  • Rosenberg, E. S., Millett, G. A., Sullivan, P. S., Del Rio, C., & Curran, J. W. (2014). Understanding the HIV disparities between black and white men who have sex with men in the USA using the HIV care continuum: A modeling study. Lancet HIV, 1, e112–e118.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rucinski, K. B., Mensah, N. P., Sepkowitz, K. A., Cutler, B. H., Sweeney, M. M., & Myers, J. E. (2013). Knowledge and use of pre-exposure prophylaxis among an online sample of young men who have sex with men in New York City. AIDS & Behavior, 17, 2180–2184.

    Article  Google Scholar 

  • Saberi, P., Gamarel, K. E., Neilands, T. B., Comfort, M., Sheon, N., Darbes, L. A., & Johnson, M. O. (2012). Ambiguity, ambivalence, and apprehensions of taking HIV-1 pre-exposure prophylaxis among male couples in San Francisco: A mixed methods study. PLoS One, 7, e50061.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Smith, D. K., Grohskopf, L. A., Black, R. J., Auerbach, J. D., Veronese, F., Struble, K. A…US Department of Health and Human Services. (2005). Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services. Morbidity & Mortality Weekly Report, 54(RR-2), 1–20.

  • Sullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A…Sanchez, T. H. (2014). Understanding racial HIV/STI disparities in black and white men who have sex with men: A multilevel approach. PLoS One, 9, e90514.

  • Turner, K. R., McFarland, W., Kellogg, T. A., Wong, E., Page-Shafer, K., Louie, B…Klausner, J. (2003). Incidence and prevalence of herpes simplex virus type 2 infection in persons seeking repeat HIV counseling and testing. Sexually Transmitted Diseases, 30, 331–334.

  • Wagnild, G. (2009). The Resilience Scale user’s guide for the US English version of the Resilience Scale and the 14-item Resilience Scale (RS-14). The Resilience Center.

Download references

Acknowledgements

This study was partially supported by the National Institute for Nursing Research (R01NR013865) and the National Institute for Mental Health (R01MH094230). The members of the POWER Study Team are as follows: Center for Black Equity: Earl D. Fowlkes, Jr., and Michael S. Hinson, Jr.; Columbia University: Alexander J. Martos and Patrick A. Wilson; University of Connecticut: Robert Baldwin, Christopher Conway-Washington, Daniel D. Driffin, Lisa A. Eaton, Harlan Smith, Chauncey Cherry, and Sabrina Cherry; and University of Pittsburgh: Patrick Buehler, Leigh Bukowski, Amy L. Herrick, Christopher Hoffmann, Derrick D. Matthews, Marcus A. Poindexter, Noah Riley, Ron D. Stall, Orrin Tiberi, Mudia Uzzi, Maurice Goodwin, and Steven Meanley.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Lisa A. Eaton.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

This study was partially supported by the National Institute for Nursing Research (R01NR013865) and the National Institute for Mental Health (R01MH094230).

Ethical Approval

This study received the IRB approval from the University of Pittsburgh, the University of Connecticut, and the Columbia University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee 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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eaton, L.A., Matthews, D.D., Driffin, D.D. et al. 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 18, 505–516 (2017). https://doi.org/10.1007/s11121-017-0756-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-017-0756-6

Keywords

Navigation