Policy- and county-level associations with HIV pre-exposure prophylaxis use, the United States, 2018

Siegler, Aaron J; Mehta, C. Christina; Mouhanna, Farah; Mera, Robertino; Castel, Amanda D.; Pembleton, Elizabeth; Jaggi, Chandni; Jones, Jeb; Kramer, Michael R.; McGuinness, Pema; McCallister, Scott; Sullivan, Patrick S.

doi:10.1016/j.annepidem.2020.03.013

Cited by 65 publications

(57 citation statements)

References 22 publications

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“…Expansion of Medicaid has been shown to be associated with improved outcomes for other health conditions [47], and the sharp decline in new HIV diagnoses in Massachusetts has been partially attributed to Medicaid expansion [48]. Similarly, states with Medicaid expansion have had better uptake of PrEP among key highrisk populations for HIV infection [49]. States also have an option for more targeted Medicaid waivers that have been used to enable access to HIV care [50].…”

Section: Discussionmentioning

confidence: 99%

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Sullivan

Knox

Jones

et al. 2021

J. Intern. AIDS Soc.

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Introduction Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community‐based cohort of Black and white MSM living with HIV in Atlanta, GA. Methods We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. Results Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age‐adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). Conclusions Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual‐level interventions to reduce racial disparities.

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Section: Discussionmentioning

confidence: 99%

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Sullivan

Knox

Jones

et al. 2021

J. Intern. AIDS Soc.

Self Cite

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“…The health benefits of Medicaid expansion are clear. It is associated with greater uptake of pre‐exposure prophylaxis (PrEP) [65], higher rates of continuous viral suppression [66] and declines in HIV incidence [67]. Moreover, greater insurance rates are associated with fewer COVID‐19 diagnoses [3].…”

Section: Discussionmentioning

confidence: 99%

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Millett

2020

J Int AIDS Soc

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Introduction The U.S. Ending the HIV Epidemic (EHE) Initiative was launched nationally in February 2019. With a target of ending the HIV epidemic by 2030, EHE initially scales up effective HIV prevention and care in 57 localities that comprise the greatest proportion of annual HIV diagnoses in the United States (US). However, the EHE effort has been eclipsed by another infectious disease 11 months into the Initiative’s implementation. SARS‐COV‐2, a novel coronavirus, has infected more than eight million Americans and at least 223 000 (as of 23 October 2020) have succumbed to the disease. This commentary explores the social conditions that place communities of colour at greater risk for COVID‐19 and HIV, and assesses challenges to EHE in a post‐COVID‐19 universe. Discussion One of the many common threads between HIV and COVID‐19 is the disproportionate impact of each disease among communities of colour. A recent report by the National Academy of Sciences surmised that as much as 70% of health outcomes are due to health access, socio‐economic factors and environmental conditions. Social determinants of health associated with greater HIV burden in Black and Brown communities have re‐emerged in epidemiological studies of disproportionate COVID‐19 cases, hospitalizations and deaths in communities of colour. Using data from the scientific literature, this commentary makes direct comparisons between HIV and COVID‐19 racial disparities across the social determinants of health. Furthermore, I examine three sets of challenges facing EHE: (1) Challenges that hamper both the EHE and COVID‐19 response (i.e. insufficiently addressing the social determinants of health; amplification of disparities as new health technologies are introduced) (2) Challenges posed by COVID‐19 (i.e. diverting HIV resources to address COVID‐19 and tapering of EHE funding generally); and (3) Challenges unrelated to COVID‐19 (i.e. emergence of new and related health disparities; repeal of the Affordable Care Act and long‐term viability of EHE). Conclusions Racism and discrimination place communities of colour at greater risk for COVID‐19 as well as HIV. Achieving and sustaining an end to the U.S. HIV epidemic will require structural change to eliminate conditions that give rise to and maintain disparities.

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“…7 Although PrEP use has increased to 19-35% among MSM, [8][9][10] challenges remain in reaching men at the highest risk. [11][12][13] PrEP use and persistence are lower for MSM who are younger (18-24 years), of racial/ethnic minorities, and living in the US South. 8,10,11,[13][14][15][16][17][18][19][20][21][22][23][24] Prior research found that condomless anal sex (CAS), substance use, lack of insurance, and other sociodemographic factors were associated with current PrEP nonuse.…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities

Kota

Stephenson

Hirshfield

et al. 2021

AIDS Patient Care and STDs

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HIV pre-exposure prophylaxis (PrEP) is a preventive medication that could reduce new infections among men who have sex with men (MSM). There are limited data on differing reasons for PrEP nonuse by condomless anal sex (CAS). We examined demographic and behavioral variables associated with PrEP use and reasons for PrEP nonuse by CAS. Data are from the M-cubed Study, collected in a 2018 baseline assessment of MSM (n = 798) in Atlanta, Detroit, and New York City. Participants reported current PrEP use (31%), previous use (8%), and never use (61%). MSM reporting CAS [adjusted odds ratio (aOR) = 2.60, confidence interval (95% CI)

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Policy- and county-level associations with HIV pre-exposure prophylaxis use, the United States, 2018

Cited by 65 publications

References 22 publications

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

New pathogen, same disparities: why COVID‐19 and HIV remain prevalent in U.S. communities of colour and implications for ending the HIV epidemic

Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities

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