Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City.
ABSTRACT To understand the factors associated with knowledge of non-occupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP), bathhouse patrons in New York City (NYC) were surveyed.
554 men who have sex with men (MSM) at two NYC bathhouses were given a standardised survey focused on nPEP and PrEP at the time of HIV testing.
In the previous 90 days, 63% of respondents reported unprotected sex with a male partner and 7% reported any sex with a known HIV-positive male partner. Less than half reported having a primary provider (primary care practitioner) who was aware of their MSM behaviour. 201 men (36%) were aware of nPEP or PrEP. In univariate analyses, race/ethnicity, previous HIV testing, gay self-identification, higher education level, having a primary provider aware of MSM behaviour, reported interaction with the healthcare system, use of the internet for meeting sex partners, reporting unprotected sex in the previous 90 days, reporting any sex with an HIV-positive male partner in the previous 90 days and having a higher number of sex partners were each significantly associated with being aware of nPEP or PrEP. In multivariate analysis, having a higher number of sex partners was significantly associated (OR 5.10, p=0.02) with post-exposure prophylaxis (PEP)/PrEP knowledge and disclosure to a primary care provider was also associated, although less robustly (OR 2.10, p=0.06).
Knowledge of nPEP or PrEP among sexually active MSM in NYC is low and is associated with having a primary provider aware of their patient's same-sex behaviours. These findings show the need for improving education about nPEP among high-risk MSM in NYC and the role of providers in these efforts.
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ABSTRACT: Pre-exposure prophylaxis (PrEP) has the potential to help reduce new HIV/AIDS infections among young men who have sex with men (YMSM); however, PrEP's accessibility and affordability remains questionable. Using a cross-sectional survey of YMSM (N=1,507; ages 18-24; 65% White, 9% Black, 17% Latino, 9% Other race/ethnicity), we gauged YMSM's PrEP awareness and PrEP-related beliefs regarding accessibility and affordability. Overall, 27% of the sample had heard about PrEP; 1% reported ever using PrEP prior to sex. In a multivariate logistic regression, we found that YMSM were more likely to have heard about PrEP if they were older (OR=1.12), more educated (OR=1.20), had insurance (OR=1.47), and reported at least one sexually-acquired infection (STI) in their lifetime (OR=1.81). We noted no differences by sexual risk behavior or race/ethnicity. Once a description of PrEP was offered to survey participants, two thirds of the sample (64.4%) noted that they would not know where to acquire PrEP, nor believed that they would able to afford it (62.4%). In multivariate linear regression models, YMSM's belief of PrEP accessibility was associated with insurance (b=.24), identifying as Latino (b=.23) or Asian (b=.42), and having heard about PrEP in the past (b=.40). PrEP affordability belief was associated with insurance (b=-.44) and a prior STI (b=.21). Black (b=-.28), Asian (b=-.07), or Other Race/Ethnicity (b=-.52) YMSM were less likely than Whites to report PrEP affordability belief. PrEP rollout may be hindered due to awareness, accessibility and affordability barriers. We propose strategies to maximize equity in PrEP awareness, access and use among YMSM.141st APHA Annual Meeting and Exposition 2013; 11/2013
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ABSTRACT: With limited exceptions, few studies have systematically reported on psychosocial and demographic characteristic differences in samples of men who have sex with men (MSM) based on where they were recruited. This study compared three sexually active cohorts of MSM recruited via Craigslist.org (recruited via modified time-space sampling), gay bars and clubs (recruited via time-space sampling), and private sex parties (identified via passive recruitment and listserves), finding mixed results with regard to differences in demographic characteristics, STI history, and psychosocial measures. Men recruited from sex parties were significantly older, reported more symptoms of sexual compulsivity, more likely to be HIV-positive, more likely to report a history of STIs, and more likely to self-identify as a barebacker, than men recruited from the other two venues. In contrast, men from Craigslist.org reported the lowest levels of attachment to the gay and bisexual community and were the least likely to self-identify as gay. Men from bars and clubs were significantly younger, and were more likely to report use of hallucinogens and crack or cocaine. Our findings highlight that the venues in which MSM are recruited have meaningful consequences in terms of the types of individuals who are reached.AIDS education and prevention: official publication of the International Society for AIDS Education 08/2014; 26(4):362-82. · 1.51 Impact Factor
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ABSTRACT: Few studies of pre-exposure prophylaxis (PrEP) to prevent HIV infection have focused on drug users. Between February to September 2013, we asked 351 opiate injectors entering detoxification treatment about HIV risk, knowledge about PrEP, and willingness to use a once daily PrEP pill under one of two randomly assigned effectiveness scenarios-40 % (low) or 90 % (high) effective in reducing HIV risk. Participants were 70 % male and 87 % non-Hispanic White. Only 7 % had heard of a drug to reduce HIV risk, yet once informed, 47 % would be willing to take such a pill [35 % of those in the low effectiveness scenario and 58 % in the high group (p < 0.001)]. Higher perceived HIV risk was associated with greater willingness to take medication. Increasing knowledge of PrEP and the rate of HIV reduction-effectiveness promised will influence its use among targeted high-risk drug users.AIDS and Behavior 04/2014; · 3.49 Impact Factor