PrEP Access Affected by COVID-19 Is Associated With Increased Odds of HIV Seroconversion

Abstract

:Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals report lower uptake and adherence to pre-exposure prophylaxis (PrEP) compared with White SMMGD. For some, the COVID-19 pandemic has resulted in reduced access to PrEP prescriptions and related changes to PrEP use, yet little is known how pandemic-related changes to PrEP access and sexual activity might influence sexually transmitted infection (STI) status and HIV seroconversion among SMMGD of color. We used data from 4 waves of a national study of Black and Hispanic/Latino SMMGD's HIV, PrEP, and health experiences to assess whether self-reported changes to sexual activity were associated with STI status, and whether self-reported changes to PrEP access were associated with HIV seroconversion. Those who reported greater impact to their sexual activity during the pandemic [adjusted odds ratio (aOR) = 1.24; 95% confidence interval (CI): 1.10 to 1.40] and a greater number of sexual partners (aOR = 1.29; 95% CI: 1.21 to 1.38) were more likely to report a positive STI test. In addition, we found that compared with those who did not report pandemic-related changes to PrEP access, those who did report changes to PrEP access had significantly higher odds of HIV seroconversion during the study period (aOR = 2.80; 95% CI: 1.02 to 7.68). These findings have implications for HIV and STI prevention and highlight the importance of novel interventions to improve PrEP access among Black and Hispanic/Latino SMMGD. Importantly, these findings also demonstrate the need to stay focused on key populations at risk of HIV infection during emerging public health crises to avoid an increase in rates of new diagnoses.

Monkeypox Vaccination Strategy and Missed Opportunities in STI and HIV Prevention: An Urban Sexual Health Clinic's Experience During a Public Health Emergency

“…Sexually transmitted infections (STIs) have been rising steadily [ 3 ], and access to pre-exposure prophylaxis (PrEP) among Black and Hispanic MSM—one of the highest-risk groups for new HIV acquisition—has declined [ 4 ]. Although vital to the task of terminating mpox transmission, prioritizing vaccination in high-risk individuals risks diverting staff and financial resources away from competing public health threats and may inadvertently threaten efforts to end the HIV epidemic.…”

New preexposure prophylaxis options need updated counseling approaches: reframing ‘risk’ in HIV prevention counseling for young sexual and gender minorities of color

“…Even when YSGM of color express interest in PrEP, their uptake is as low as 5% [12][13][14][15]. The novel coronavirus disease (COVID)-19 global pandemic has further exacerbated HIV testing and PrEP barriers, particularly for black and Hispanic/Latino YSGM individuals [16]. With the advent of options like long-acting injectables, there are increasing and more diverse options for PrEP.…”

“…An oft-cited barrier to PrEP uptake is perceived judgement from healthcare providers, which prevents candid conversations about sexual health including but not limited to PrEP [16][17][18][19]. Research shows that poor client-provider communication leads to negative client outcomes, including nonadherence to medical treatment, poor client satisfaction, and lack of trust in providers [18].…”

COVID-19, Vaccine Hesitancy, and HIV Pre-exposure Prophylaxis Among Black Sexual Minority Men

“…[19][20][21] The barriers to health care access described, including a loss of insurance and broad socioeconomic difficulties, may directly prevent BSMM accessing PrEP or create undue complexities in navigating it. 22,23 In addition, many BSMM access PrEP through community-based services that often rely on strong social networks; these networks may be weakened given the increased distancing and isolation presented by the pandemic. 24,25 Distrust in health care systems and discrimination were exacerbated during the pandemic; these are welldocumented barriers to PrEP use.…”