A Medical Care Missed Opportunity: Preexposure Prophylaxis and Young Black Men Who Have Sex With Men

Abstract

HIV disproportionately impacts young Black men who have sex with men (YBMSM). Pre-exposure prophylaxis (PrEP) is an effective strategy that can avert new HIV infections in YBMSM. Barriers exist for YBMSM to access PrEP. We sought to determine factors associated with awareness of and willingness to take PrEP in a sample of YBMSM. Only 8% were currently on PrEP despite many (66%) reporting condomless anal sex, a recent provider visit (54%), disclosing their sexual orientation to their regular medical provider (62%), or a willingness to take PrEP (62%). In bivariate analysis, increased number of lifetime partners, current PrEP use, and disclosure of sexual orientation to a doctor were associated with awareness of PrEP, while condomless anal sex and higher perceived risk was associated with willingness to take PrEP. Sex with females was associated with lower willingness. Providers may be missing key opportunities to educate YBMSM about PrEP and incorporate PrEP into comprehensive sexual health care.

Characteristics of the Provider-Patient Encounter Associated With Awareness of and Willingness to Take PrEP Among Young Minority Urban Males in Baltimore City

“…The proportions of patients who expressed awareness of and willingness to take PrEP in our population were similar to those noted in other studies (Arrington-Sanders et al, 2016;Eaton, Matthews et al, 2017;Philbin et al, 2016). Being asked by a provider about sexual-related behaviors and one's sexual orientation and having been hurt by a partner increased the odds of willingness to take PrEP, as did having provider-initiated discussions about HIV/STI risk reduction and condom use.…”

“…Coming to see a provider to get condoms or for STI testing were both associated with willingness to take PrEP, whereas coming to the provider for a routine or non-STD related sick visit were not associated with either awareness of or willingness to take PrEP. These findings extend prior studies that have found that individuals reporting higher-risk sexual behaviors are more willing to take PrEP, and identify visit type opportunities that providers should not miss to discuss and offer prep, as indicated (Arrington-Sanders et al, 2016;Jones et al, 2014;Perez-Figueroa, Kapadia, Barton, Eddy, & Halkitis, 2015). Further study is needed in how to promote providers to take advantage of such opportunities to augment PrEP uptake among those patients who are ready.…”

“…Several studies have explored individual-level characteristics and behaviors that affect awareness of PrEP as well as willingness to take a preventive medication daily particularly among priority populations (Fallon, Park, Ogbue, Flynn, & German, 2017;Garnett et al, 2018;Holloway et al, 2017). PrEP awareness has been shown to be significantly associated with recent HIV/STI testing, perceived HIV risk, higher number of sex partners, and intermittent/lack of condom use; willingness to take PrEP has been associated with concerns about side effects, PrEP-associated stigma, and medical mistrust (Arrington-Sanders et al, 2016;Eaton, Kalichman et al, 2017;Eaton, Matthews et al, 2017;Garcia & Harris, 2017;Kwakwa et al, 2016;Philbin et al, 2016;Underhill et al, 2015). Some studies have also highlighted the potential impact of clinic-based approaches to change provider and staff behavior, such as implementing cultural competency training to reduce medical mistrust and perceived racism in clinic settings, and encouraging providers to reduce missed opportunities for talking to high-risk patients about PrEP when patients disclose information to their providers about sexual behaviors or risk (Arrington-Sanders et al, 2016;Cahill et al, 2017;Kwakwa et al, 2016).…”

Disclosure of Same-Sex Behaviors to Health-care Providers and Uptake of HIV Testing for Men Who Have Sex With Men: A Systematic Review

“…In most of the studies, they were young and lived in or migrated into big cities. Several of studies conducted in the United States focused on ethnic minorities including African American ( Arrington-Sanders et al, 2016 ) and Hispanic/Latino populations ( Joseph et al, 2014 ; Oster et al, 2013 ).…”

“…In most of the studies, the target of disclosure was generally referred as health-care providers. Some studies used the term “doctors” and “physicians” ( Koch et al, 2016 ; Petroll & Mosack, 2011 ), some used the term “(regular) doctor, nurse, or healthcare providers” ( Ramirez-Valles et al, 2014 ; Wall et al, 2010 ), or “health-care professional” ( Ng et al, 2014 ; Tang et al, 2017 ; Wilkerson et al, 2010 ) or “medical provider” ( Arrington-Sanders et al, 2016 ). Some studies explicitly focused on general practitioners (GPs) ( Fitzpatrick et al, 1994 ; Ludlam et al, 2015 ; Metcalfe et al, 2015 ) and primary health-care provider ( Marcus et al, 2015 ; Petroll & Mitchell, 2015 ).…”