DOI: 10.1097/QAI.0000000000001139
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PMID: 27454249
Issn Print: 1525-4135
Publication Date: 2016/11/01
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Excerpt
Since May 2014, the Centers for Disease Control and Prevention (CDC) has recommended the use of preexposure prophylaxis (PrEP) for sexually active men who have sex with men (MSM) who report one of the following: an HIV-positive partner, a recent bacterial sexually transmitted infection, a high number of sex partners, a history of inconsistent or no condom use, or a history of commercial sex work.1 Male-to-male sexual contact is the most common route of HIV transmission among men in Philadelphia. In 2014, 319 (65%) of the 492 newly diagnosed HIV cases among male Philadelphia residents reported MSM as a transmission risk.2 PrEP has the potential to prevent HIV transmission among HIV-negative MSM but only if acceptance of and adherence to the medication is high. We used survey responses from the National HIV Behavioral Surveillance System (NHBS) in Philadelphia to evaluate the acceptability of PrEP among HIV-negative MSM and characteristics associated with the willingness to use PrEP. In particular, we sought to identify the acceptability of PrEP among the MSM population subgroups at a greatest risk of HIV acquisition, including MSM with a high number of sexual partners and those engaging in unprotected anal sex in the past year, to inform potential interventions.
NHBS is a CDC-funded national surveillance system that collects cross-sectional behavioral data in 20 US cities among populations at the high risk for acquiring HIV, including MSM, persons who inject drugs, and heterosexuals at an increased risk for HIV infection. Our study uses survey responses from the fourth NHBS MSM cycle in Philadelphia conducted from August to November 2014.
A total of 709 MSM were interviewed during this cycle. This analysis excludes respondents who self-reported being HIV positive (n = 132, 18.6%), did not complete relevant questions regarding PrEP use (n = 9, 1%), or declined HIV testing (n = 31, 4.4%). The final study population includes 537 MSM. Philadelphia's NHBS MSM4 survey was supplemented with a brief statement explaining PrEP and several follow-up questions including, “Would you be willing to take the pill PrEP every day to lower your chances of getting HIV?” Possible responses included “yes,” “no,” and “don't know.” Our primary outcome was an affirmative response to this question. HIV-negative MSM reporting prior or current use of PrEP (n = 35, 6.5%) were also included in the analysis as those willing to take PrEP. Associations of the outcome with sociodemographic variables (age, race/ethnicity, poverty status, education level, employment status, history of homelessness, health insurance status and type, reporting a visit to a health care provider in the past year) and risk behaviors (history of injecting drugs, noninjection drug use in the past year, cocaine use in the past year, binge drinking) were evaluated. Sexual behavior risk variables include reported sexual identity, outness, sex with a woman in the past year, any sexually transmitted infection in the past year, total number of sex partners in the past year, number of unprotected anal sex partners in the past year, and any exchange sex in the past year. Behaviors at the last sexual encounter were also examined, including partner type, partner's HIV status, condomless insertive or receptive anal sex, relationship length, relative age of partner, and substance use during sex. HIV testing and prevalence variables included ever tested for HIV, testing in the past year, and HIV-positive status at postinterview testing.
