Determinants of Pre-exposure Prophylaxis among Men Who have Sex with Men: Houston, 2014

Pre-exposure prophylaxis (PrEP) has been shown to prevent as many as 90% of HIV cases, yet it is not widely used by people at high risk for the disease. In the United States, men who have sex with other men (MSM) are especially vulnerable, making up two-thirds of new diagnoses. Potential factors associated with PrEP uptake among MSM have been suggested. These include disparities by race and social class. Barriers may also exist, such as inability to access healthcare resources, and failure of doctors to inform at-risk patients about PrEP. In addition, PrEP uptake may be associated with riskier behaviors. People taking PrEP may engage in riskier behaviors, as they are more protected against HIV infection than they would be without PrEP. To further explore factors associated with PrEP awareness and usage among MSM, we analyzed data from the Houston chapter of the National HIV Behavioral Surveillance Program, collected in 2014. Demographics, access to healthcare, and behavioral variables were studied as potential predictors of PrEP awareness and usage in the past year. Crude odds ratios and 95% confidence ratios were reported. Adjusted odds ratios for PrEP awareness were estimated via logistic regression, clustered by recruitment venue. Among 348 MSM who did not self-report as HIV-positive, 46.3% had heard of PrEP before, and 2.9% had taken it in the past year. The odds of PrEP awareness were higher among white MSM than Hispanic MSM, but did not differ greatly between white MSM and black MSM, or white MSM and MSM of mixed or other races. Higher income level, having education beyond high school, and having been tested for HIV were also associated with knowing about PrEP. PrEP usage was most highly associated with having had a bacterial STD in the past year. Thus, there is evidence of disparities in PrEP awareness in this study population, based on race and socioeconomic status. Continued education of healthcare providers regarding PrEP may increase the uptake of the drug by MSM. More research may determine whether those who take PrEP may be more likely to engage in riskier behaviors