Understanding the impact of a syndemic on the use of pre-exposure prophylaxis in a community-based sample of behaviorally PrEP-eligible BMSM in the United States

ABSTRACT

HIV Pre-Exposure Prophylaxis (PrEP) has shown great promise in reducing HIV transmission among affected populations; however, PrEP uptake among Black men who have sex with men (BMSM) has stalled. This study compares BMSM using PrEP and BMSM at risk for HIV not using PrEP based on differences in behavior, psychosocial conditions and the presence of a syndemic (n = 1,411). BMSM reporting PrEP use were significantly more likely to report three of five HIV risk behaviors and three of four psychosocial conditions. Odds of reporting PrEP use increased as the number of psychosocial conditions increased such that BMSM with three psychosocial conditions (AOR = 5.65, 95% CI: 3.17, 10.08) and four conditions (AOR = 18.34, 95% CI: 5.01, 67.20) demonstrated significantly greater odds of PrEP use compared to BMSM reporting one or less conditions. While BMSM at greatest risk are using PrEP, strategies are still needed for men at varying risk levels.

KEYWORDS:

• Pre-exposure prophylaxis
• black men who have sex with men
• syndemic
• psychosocial conditions
• chemoprophylaxis

Acknowledgements

We thank the Center for Black Equity and local Black Pride organizations for partnering with us to implement POWER, the community based organizations who performed onsite HIV testing on the study’s behalf, the thousands of study participants who volunteered their time to contribute to this research, and members of the POWER Study Team who made data collection possible. The local Black Pride organizations are as follows: D.C. Black Pride, Detroit’s Hotter than July, Houston Splash, In the Life Atlanta, Memphis Black Pride, and Philadelphia Black Pride. The community based organizations who performed onsite HIV testing are as follows: Atlanta: AID Atlanta, AIDS Health Care Foundation, NAESM; Detroit: Community Health Awareness Group, Horizons Project, Unified; Houston: Avenue 360, Houston AIDS Foundation, Positive Efforts; Memphis: Friends for Life; Philadelphia: Access Matters, Philadelphia FIGHT; Washington, D.C.: Us Helping Us.

Disclosure statement

There are no conflicts of interest to report from the authors. This original, unpublished manuscript has not been submitted for review to any other journal, and has been read and approved by all co-authors. All study procedures were approved by the University of Pittsburgh Institutional Review Board.

ORCID

Cristian J. Chandler http://orcid.org/0000-0003-1770-4357

Additional information

Funding

This study was partially supported by the National Institute for Nursing Research [grant number R01NR013865] and a National Institutes of Health training grant [grant number T32MH904174-07]. The funding agencies had no involvement in the study design, analysis or interpretation of data, the writing of the report, or the decision to submit for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health; National Institute of Mental Health.