Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use Among Stimulant Versus Alcohol Using Men Who Have Sex with Men

Abstract

Alcohol and stimulant use are independently associated with increased HIV acquisition among men who have sex with men (MSM). We assessed differences in acceptability and perceived barriers to uptake of pre-exposure prophylaxis (PrEP) among stimulant and alcohol-using MSM in Boston. From September 2012–2013, a quantitative assessment was conducted with 254 MSM respondents who reported recent condomless sex in the context of concurrent stimulant (crack/cocaine and crystal methamphetamine; n=132) or alcohol use (n=122). Thirteen (5.1%) reported previous PrEP use. In multivariable models, stimulant users were more likely to be concerned that substance use would affect PrEP adherence (aRR=2.79, 95% CI 1.63–4.77), and were less concerned about HIV stigma as a barrier to PrEP uptake (aRR=0.52, 95% CI 0.30–0.90) compared to alcohol users. Barriers to PrEP uptake and adherence differ by type of substance used. Different strategies may be required for PrEP implementation among MSM who use stimulants and alcohol.

The “Safe Sex” Conundrum: Anticipated Stigma From Sexual Partners as a Barrier to PrEP Use Among Substance Using MSM Engaging in Transactional Sex

“…All participants were over the age of 18, born biologically male, identified as male at the time of enrollment and HIV-negative at the time of enrollment (as con-firmed by antibody test). Details of recruitment are provided elsewhere [16]. In brief, 254 men were recruited at dance clubs and bars that are frequented by gay, bisexual men and other MSM in the greater-Boston area, through sexual partner-meeting websites for MSM, and at LGBT-oriented health centers and community-based organizations in Massachusetts.…”

“…Barriers to PrEP uptake and adherence have been examined among MSM, and include cost, perceived efficacy, concerns about side effects and not wanting to take a daily pill [12–15]. However, studies examining barriers to PrEP initiation and adherence are limited among sub-groups of high-risk MSM who may benefit from it the most, including those who are dependent on alcohol/drugs and those who engage in transactional sex [16]–[18]. Understanding perceptions of PrEP and its use among MSM with different risk profiles is necessary for the development of contextually relevant PrEP promotion strategies targeted to unique sub-groups of MSM.…”

Mental health in 2020 for men who have sex with men in the United States

“…Whereas MSM who used alcohol in the context of condomless anal sex were more likely to cite PrEP stigma as a deterrent to PrEP usage. 59 As additional PrEP-related research is conducted leading up to 2020, we can expect to learn more about the psychological barriers to PrEP uptake and adherence, including substance use and stigma.…”

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men

“…Multiple factors, however, have impeded access to and interest in taking PrEP among MTW. Main barriers to use include a lack of wide-spread messaging to promote PrEP in communities of elevated HIV prevalence, costs associated concerns among individuals with no/limited insurance, lack of prescribing providers [10], concerns regarding side-effects and long-term use, and sociocultural barriers to use [11], such as experiences of stigma [12, 13] and other negative beliefs about its use [14]. …”