Structural Issues Associated with Pre-exposure Prophylaxis Use in Men Who Have Sex with Men.
HIV
MSM
Pre-exposure prophylaxis (PrEP)
Prevention
Socioeconomic factors
Journal
International journal of behavioral medicine
ISSN: 1532-7558
Titre abrégé: Int J Behav Med
Pays: England
ID NLM: 9421097
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
accepted:
26
03
2021
pubmed:
10
4
2021
medline:
30
10
2021
entrez:
9
4
2021
Statut:
ppublish
Résumé
Limited access to healthcare has been associated with limited uptake of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM). This descriptive analysis examined, in a near universal healthcare setting, differences between MSM reporting using versus not using PrEP in the past 12 months. Data come from the 2017 Boston sample of the National HIV Behavioral Surveillance (NHBS) system, containing a venue-based and time-spaced sample of 530 MSM. The analysis used descriptive frequencies and tests of bivariate associations by PrEP use using Fisher's exact test. Five hundred four respondents had data necessary to determine if PrEP was indicated, and 233 (43.9%) had an indication for PrEP. Of these 233 participants, 117 (50.2%) reported using PrEP in the past 12 months. Not being out, in terms of disclosing one's sexual orientation to a healthcare provider, lack of health insurance, limited access to healthcare, and history of incarceration were all significantly associated with not using PrEP in the past 12 months. Race/ethnicity was not significantly associated with PrEP use in the past 12 months. In the setting of Massachusetts healthcare expansion and reform, and in a sample somewhat uncharacteristic of the population of individuals experiencing difficulties accessing PrEP, structural and demographic factors remain potent barriers to PrEP uptake. Targeted PrEP expansion efforts in Massachusetts may focus on identifying vulnerable subgroups of MSM (e.g., underinsured or criminal justice system-involved MSM) and delivering evidence-based interventions to reduce stigma and promote disclosure of same-sex behavior in healthcare settings.
Sections du résumé
BACKGROUND
BACKGROUND
Limited access to healthcare has been associated with limited uptake of pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM). This descriptive analysis examined, in a near universal healthcare setting, differences between MSM reporting using versus not using PrEP in the past 12 months.
METHOD
METHODS
Data come from the 2017 Boston sample of the National HIV Behavioral Surveillance (NHBS) system, containing a venue-based and time-spaced sample of 530 MSM. The analysis used descriptive frequencies and tests of bivariate associations by PrEP use using Fisher's exact test.
RESULTS
RESULTS
Five hundred four respondents had data necessary to determine if PrEP was indicated, and 233 (43.9%) had an indication for PrEP. Of these 233 participants, 117 (50.2%) reported using PrEP in the past 12 months. Not being out, in terms of disclosing one's sexual orientation to a healthcare provider, lack of health insurance, limited access to healthcare, and history of incarceration were all significantly associated with not using PrEP in the past 12 months. Race/ethnicity was not significantly associated with PrEP use in the past 12 months.
CONCLUSIONS
CONCLUSIONS
In the setting of Massachusetts healthcare expansion and reform, and in a sample somewhat uncharacteristic of the population of individuals experiencing difficulties accessing PrEP, structural and demographic factors remain potent barriers to PrEP uptake. Targeted PrEP expansion efforts in Massachusetts may focus on identifying vulnerable subgroups of MSM (e.g., underinsured or criminal justice system-involved MSM) and delivering evidence-based interventions to reduce stigma and promote disclosure of same-sex behavior in healthcare settings.
Identifiants
pubmed: 33834369
doi: 10.1007/s12529-021-09986-w
pii: 10.1007/s12529-021-09986-w
pmc: PMC8497652
mid: NIHMS1687477
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
759-767Subventions
Organisme : NCCIH NIH HHS
ID : K24 AT009465
Pays : United States
Organisme : NCCIH NIH HHS
ID : T32 AT000051
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI007433
Pays : United States
Organisme : National Institute of Allergy and Infectious Diseases
ID : 5P30AI060354-15
Organisme : NIAID NIH HHS
ID : P30 AI060354
Pays : United States
Informations de copyright
© 2021. International Society of Behavioral Medicine.
Références
PLoS One. 2017 May 30;12(5):e0178737
pubmed: 28558067
PLoS One. 2018 Dec 7;13(12):e0205593
pubmed: 30532275
AIDS. 2015 Apr 24;29(7):837-45
pubmed: 25730508
AIDS Behav. 2018 Apr;22(4):1063-1074
pubmed: 28176168
Am J Public Health. 2017 Feb;107(2):267-273
pubmed: 27997242
Am J Public Health. 2014 Mar;104(3):448-54
pubmed: 24432948
AIDS Behav. 2018 Apr;22(4):1201-1208
pubmed: 28815361
Int J STD AIDS. 2015 Dec;26(14):1028-34
pubmed: 25527656
J Acquir Immune Defic Syndr. 2017 Mar 1;74(3):285-292
pubmed: 28187084
J Acquir Immune Defic Syndr. 2017 Apr 15;74(5):531-538
pubmed: 27861236
AIDS Educ Prev. 2015 Apr;27(2):112-25
pubmed: 25915697
Ann Epidemiol. 2018 Dec;28(12):833-840
pubmed: 30037634
Psychol Med. 2002 Aug;32(6):959-76
pubmed: 12214795
AIDS Care. 2011 Sep;23(9):1136-45
pubmed: 21476147
N Engl J Med. 2010 Dec 30;363(27):2587-99
pubmed: 21091279
PLoS One. 2020 Apr 17;15(4):e0231951
pubmed: 32302371
J Acquir Immune Defic Syndr. 2013 Aug 15;63(5):e167-70
pubmed: 24135782
Lancet. 2012 Jul 28;380(9839):424-38
pubmed: 22819663
PLoS One. 2012;7(3):e33119
pubmed: 22470438
MMWR Morb Mortal Wkly Rep. 2019 Jul 12;68(27):597-603
pubmed: 31298662
JAMA. 2019 Mar 5;321(9):844-845
pubmed: 30730529
Lancet. 2020 Jul 25;396(10246):239-254
pubmed: 32711800
AIDS Behav. 2017 May;21(5):1350-1360
pubmed: 27848089
AIDS Behav. 2018 Apr;22(4):1080-1095
pubmed: 29285638
AIDS. 2017 Mar 13;31(5):731-734
pubmed: 28060019
LGBT Health. 2017 Aug;4(4):310-314
pubmed: 28514200
Alcohol Res Health. 2010;33(3):195-202
pubmed: 23584061
J Int AIDS Soc. 2020 Mar;23(3):e25461
pubmed: 32153119
Lancet. 2016 Jan 2;387(10013):53-60
pubmed: 26364263
Health Justice. 2019 Apr 13;7(1):7
pubmed: 30982117
BMC Public Health. 2013 May 17;13:482
pubmed: 23679953
N Engl J Med. 2015 Dec 3;373(23):2237-46
pubmed: 26624850
PLoS Med. 2014 Mar 04;11(3):e1001613
pubmed: 24595035
J Infect Dis. 2016 Dec 15;214(12):1800-1807
pubmed: 27418048
Soc Work Health Care. 2014;53(5):460-77
pubmed: 24835090
Sex Health. 2018 Nov;15(6):522-527
pubmed: 30476461
AIDS Behav. 2018 Aug;22(8):2743-2755
pubmed: 29550942
AIDS Behav. 2014 Jul;18(7):1272-8
pubmed: 24569888