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
Lisa A. Eaton A B , Daniel D. Driffin A , Harlan Smith A , Christopher Conway-Washington A , Denise White A and Chauncey Cherry AA University of Connecticut, Storrs, CT 06269, USA.
B Corresponding author. Email: lisaanne.eaton@gmail.com
Sexual Health 11(3) 244-251 https://doi.org/10.1071/SH14022
Submitted: 6 August 2013 Accepted: 4 March 2014 Published: 8 July 2014
Abstract
Objectives: In the US, Black men who have sex with men (BMSM) are disproportionately affected by HIV/AIDS. Pre-exposure prophylaxis (PrEP) holds tremendous promise for curbing the HIV/AIDS epidemic among these men. However, many psychosocial components must be addressed in order to implement this prevention tool effectively among BMSM. Methods: We assessed PrEP knowledge and use, health care access experiences, race-based medical mistrust, sexual partners and behaviours, and drug and alcohol use among 699 men attending a community event in the south-eastern United States. We used generalised linear modelling to assess factors associated with their willingness to use PrEP. Results: Three hundred and ninety-eight men reported being BMSM and having HIV-negative status. Among these men, 60% reported being willing to use PrEP. Lack of being comfortable with talking to a health care provider about having sex with men, not having discussed having sex with a man with a health care provider, race-based medical mistrust, and alcohol consumption and substance use were all identified as barriers to willingness to use PrEP. Sexual risk-taking, number of sex partners and STI diagnosis were not associated with willingness to use PrEP. Conclusions: Findings from the current paper demonstrate the importance of acknowledging the role of various psychosocial factors in the uptake of PrEP. It is imperative that we prioritise research into understanding these barriers better, as the failure to do so will impede the tremendous potential of this prevention technology.
Additional keywords: health care, knowledge, medical mistrust, PrEP, substance use.
References
[1] Centers for Disease Control and Prevention (CDC). CDC fact sheet. HIV and AIDS among gay and bisexual men. Atlanta: CDC; 2010. Available online at: http://www.cdc.gov/hiv/risk/gender/msm/ [verified May 2014].[2] Sullivan PS, Hamouda O, Delpech V, Geduld JE, Prejean J, Semaille C, et al Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005. Ann Epidemiol 2009; 19 423–31.
| Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996–2005.Crossref | GoogleScholarGoogle Scholar | 19460672PubMed |
[3] US Department of Commerce (USDC). State & county quick facts. Washington DC: USDC; 2008. Available online at: http://quickfacts.census.gov/qfd/states/00000.html [verified March 2014].
[4] Koblin B. Correlates of HIV incidence among Black men who have sex with men in 6 U.S. cities (HPTN 061). In: Proceedings of the 19th International AIDS Conference; 22–27 July 2012; Washington, DC, USA. 2012. Abstract MOAC0106.
[5] Centers for Disease Control and Prevention (CDC). HIV among African Americans. Atlanta: CDC; 2011. Available online at: http://www.cdc.gov/hiv/risk/racialethnic/bmsm/facts/index.html [verified November 2012].
[6] Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.
| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXit1ansg%3D%3D&md5=091a35e1d710da4786fd48a26de243edCAS | 21091279PubMed |
[7] Liu AY, Kittredge PV, Vittinghoff E, Raymond HF, Ahrens K, Matheson T, et al Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men. J Acquir Immune Defic Syndr 2008; 47 241–7.
| Limited knowledge and use of HIV post- and pre-exposure prophylaxis among gay and bisexual men.Crossref | GoogleScholarGoogle Scholar | 18340656PubMed |
[8] Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education. J Acquir Immune Defic Syndr 2009; 50 77–83.
| Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education.Crossref | GoogleScholarGoogle Scholar | 19295337PubMed |
[9] Kellerman SE, Hutchinson AB, Begley EB, Boyett BC, Clark HA, Sullivan P. Knowledge and use of HIV pre-exposure prophylaxis among attendees of minority gay pride events, 2004. J Acquir Immune Defic Syndr 2006; 43 376–7.
| Knowledge and use of HIV pre-exposure prophylaxis among attendees of minority gay pride events, 2004.Crossref | GoogleScholarGoogle Scholar | 17079995PubMed |
[10] Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr 2010; 54 548–55.
| Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20512046PubMed |
[11] Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS 2013; 27 248–54.
| From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.Crossref | GoogleScholarGoogle Scholar | 23565928PubMed |
[12] Centers for Disease Control and Prevention (CDC). HIV in the United States: Stages of Care. Atlanta: CDC; 2012. Available online at: http://www.cdc.gov/hiv/pdf/research_mmp_StagesofCare.pdf [verified March 2014].
[13] Christopoulos KA, Das M, Colfax GN. Linkage and retention in HIV care among men who have sex with men in the United States. Clin Infect Dis 2011; 52 S214–22.
| Linkage and retention in HIV care among men who have sex with men in the United States.Crossref | GoogleScholarGoogle Scholar | 21342910PubMed |
[14] Mayer KH. Introduction: linkage, engagement, and retention in HIV care: essential for optimal individual- and community-level outcomes in the era of highly active antiretroviral therapy. Clin Infect Dis 2011; 52 S205–7.
| Introduction: linkage, engagement, and retention in HIV care: essential for optimal individual- and community-level outcomes in the era of highly active antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 21342908PubMed |
[15] Giordano TP, Hartman C, Gifford AL, Backus LI, Morgan RO. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials 2009; 10 299–305.
| Predictors of retention in HIV care among a national cohort of US veterans.Crossref | GoogleScholarGoogle Scholar | 19906622PubMed |
[16] Ulett KB, Willig JH, Lin HY, Routman JS, Abroms S, Allison J, et al The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS 2009; 23 41–9.
| The therapeutic implications of timely linkage and early retention in HIV care.Crossref | GoogleScholarGoogle Scholar | 19055408PubMed |
[17] Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health 1997; 87 1773–8.
| Under the shadow of Tuskegee: African Americans and health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FjtlChuw%3D%3D&md5=6796eee3fe0b0e884a1008fd67d2ecd4CAS | 9366634PubMed |
[18] Al-Tayyib AA, Thrun MW, Haukoos JS, Walls NE. Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men in Denver, Colorado. AIDS Behav 2013; 18 340–7.
| Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men in Denver, Colorado.Crossref | GoogleScholarGoogle Scholar |
[19] Rucinski KB, Mensah NP, Sepkowitz KA, Cutler BH, Sweeney MM, Myers JE. Knowledge and use of pre-exposure prophylaxis among an online sample of young men who have sex with men in new york city. AIDS Behav 2013; 17 2180–4.
| Knowledge and use of pre-exposure prophylaxis among an online sample of young men who have sex with men in new york city.Crossref | GoogleScholarGoogle Scholar | 23479003PubMed |
[20] Halkitis PN, Zade DD, Shrem M, Marmor M. Beliefs about HIV non-infection and risky sexual behavior among MSM. AIDS Educ Prev 2004; 16 448–58.
| Beliefs about HIV non-infection and risky sexual behavior among MSM.Crossref | GoogleScholarGoogle Scholar | 15491956PubMed |
[21] Eaton LA, Kalichman SC, Cherry C. Sexual partner selection and HIV risk reduction among Black and White men who have sex with men. Am J Public Health 2010; 100 503–9.
| Sexual partner selection and HIV risk reduction among Black and White men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20075328PubMed |
[22] Eaton LA, West TV, Kenny DA, Kalichman SC. HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection. AIDS Behav 2009; 13 185–95.
| HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection.Crossref | GoogleScholarGoogle Scholar | 18953645PubMed |
[23] Thompson HS, Valdimarsdottir HB, Winkel G, Jandorf L, Redd W. The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening. Prev Med 2004; 38 209–18.
| The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening.Crossref | GoogleScholarGoogle Scholar | 14715214PubMed |
[24] Shelton RC, Winkel G, Davis SN, Roberts N, Valdimarsdottir H, Hall SJ, et al Validation of the group-based medical mistrust scale among urban Black men. J Gen Intern Med 2010; 25 549–55.
| Validation of the group-based medical mistrust scale among urban Black men.Crossref | GoogleScholarGoogle Scholar | 20195782PubMed |
[25] Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction 1993; 88 791–804.
| Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3szitVOltw%3D%3D&md5=76bff0bf4cdbd1f4c3e7fb5fdbb0fd73CAS | 8329970PubMed |
[26] Aiken L, West S. Multiple regression: testing and interpreting interactions. Newbury Park: Sage. 1991.
[27] LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev 2000; 57 146–61.
| Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients.Crossref | GoogleScholarGoogle Scholar | 11092161PubMed |
[28] Hammond WP. Psychosocial correlates of medical mistrust among African American men. Am J Community Psychol 2010; 45 87–106.
| Psychosocial correlates of medical mistrust among African American men.Crossref | GoogleScholarGoogle Scholar | 20077134PubMed |
[29] Bynum SA, Davis JL, Green BL, Katz RV. Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older. Am J Health Promot 2012; 26 295–300.
| Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older.Crossref | GoogleScholarGoogle Scholar | 22548424PubMed |
[30] Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis 2013; 57 1164–71.
| The state of engagement in HIV care in the United States: from cascade to continuum to control.Crossref | GoogleScholarGoogle Scholar | 23797289PubMed |
[31] Vallabhaneni S, Li X, Vittinghoff E, Donnell D, Pilcher CD, Buchbinder SP. Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men. PLoS ONE 2012; 7 e45718
| Seroadaptive practices: association with HIV acquisition among HIV-negative men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhsFWgsb7F&md5=7cc2657fc77b9b5906e3719cf397f1adCAS | 23056215PubMed |
[32] McFarland W, Chen YH, Nguyen B, Grasso M, Levine D, Stall R, et al Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use. AIDS Behav 2012; 16 121–31.
| Behavior, intention or chance? A longitudinal study of HIV seroadaptive behaviors, abstinence and condom use.Crossref | GoogleScholarGoogle Scholar | 21644001PubMed |
[33] Mansergh G, Koblin BA, Colfax GN, McKirnan DJ, Flores SA, Hudson SM. Preefficacy use and sharing of antiretroviral medications to prevent sexually-transmitted HIV infection among US men who have sex with men. J Acquir Immune Defic Syndr 2010; 55 e14–6.
| Preefficacy use and sharing of antiretroviral medications to prevent sexually-transmitted HIV infection among US men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 20859085PubMed |