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The impact of socio-environmental factors on doxyPEP awareness in the United States (US): a cross-sectional study

Krishen Samuel, Matthew Ellis, Mance Buttram

Abstract

Background: We investigated awareness and use of doxycycline post-exposure prophylaxis (doxyPEP) in the US. DoxyPEP has preventative benefits for bacterial STIs among people assigned male at birth. We considered how individual, interpersonal, and social determinants of health, such as state-level LGBTQ equality, impact doxyPEP awareness. Methods: We conducted an online snapshot cross-sectional survey in June 2023. Survey questions included demographics, sexual and substance use behaviors, socio-environmental factors, and provided a short explanation of doxyPEP, with questions regarding prior awareness and use. Results: Among a racially diverse sample of 196 participants (median age: 33), 94% identified as cisgender men, 26% were aware of doxyPEP, while only 14 (7%) had ever used it. Factors significantly associated with awareness included being college educated (OR: 2.50, 95% CI 1.09-5.74), a past year bacterial STI (OR: 4.20, 95% CI 1.97-8.89), having discussed HIV pre-exposure prophylaxis (PrEP) with a healthcare provider (OR: 3.88, 95% CI 1.99-7.57) and having taken HIV PrEP (OR: 2.29, 95% CI 1.11-4.70). Socio-environmental factors associated with doxyPEP awareness included living in a large urban city (OR: 2.14, 95% CI 1.12-4.10) and living in a state with higher levels of LGBTQ policy equality (OR: 2.18, 95% CI 1.07-4.44). Conclusions: Considering the disproportionate impact of bacterial STIs on men who have sex with men, especially those living in lower LGBTQ equality regions such as the Southern US, our study emphasizes how socio-environmental factors may limit awareness and uptake of novel biomedical approaches that have the potential to prevent morbidity and enhance sexual health.

SH23176  Accepted 19 April 2024

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