Syndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men

Abstract

Young Latino men who have sex with men (MSM) are a highly vulnerable population for HIV infection. Pre-exposure prophylaxis (PrEP) is a novel biomedical HIV prevention tool that may aid in reducing the disparity in HIV incidence among Latino MSM. However, PrEP use is disproportionally low among Latino MSM and, therefore, identifying barriers along the PrEP continuum of care (the "PrEP cascade") would provide insight into how to best deploy PrEP interventions. Syndemics theory is a prominent framework employed in HIV prevention; however, to date, no known studies have applied this theory to PrEP. Thus, the aim of the current study was to explore the association between syndemics and the PrEP cascade, including the degree to which psychosocial and structural syndemic constructs are related to the PrEP cascade. Participants were 151 young Latino MSM (M age = 24 years; SD = 3) residing in San Diego, California, who completed a battery of online self-report measures. Results indicated high levels of syndemic indicators and varying levels of engagement across the PrEP cascade. As syndemic indicators increased, the odds of engagement across the PrEP cascade were significantly lowered. Psychosocial and structural syndemic factors accounted for unique variance in the PrEP cascade. Results highlight the need for combination interventions that address both psychosocial and structural barriers to PrEP use and persistence among young Latino MSM.

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

“…We found no differences in PrEP use for Black and Hispanic/Latino MSM compared with White MSM, similar to other recent studies 8,44,54,55 but in contrast with earlier research. 10,[16][17][18] This could be due to biases in our sample, which was recruited from urban areas and highly educated, similar to studies that found no significant racial/ethnic differences in PrEP use when controlled for urbanicity and education levels. 8,44 However, given that MSM of color have higher HIV incidence than White MSM, equivalent levels of PrEP use might still not translate to equitable prevention and widen disparities in HIV incidence.…”

“…[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. 8,19,[25][26][27] Research on PrEP discontinuation is increasing; associated factors are younger age, substance use, fewer sex partners, being single, and lack of insurance.…”

“…8,19,[25][26][27] Research on PrEP discontinuation is increasing; associated factors are younger age, substance use, fewer sex partners, being single, and lack of insurance. 17,19,22 Examining sociodemographic and behavioral variables associated with PrEP use status (currently using, previously used, never used) could provide information to tailor interventions for specific subgroups of MSM.…”

Estimating HIV transmissions in a large U.S. clinic‐based sample: effects of time and syndemic conditions

“…A future direction of study is the measurement of structural syndemic conditions (e.g. housing instability, criminal justice involvement, poverty [43,79]) to understand how structural barriers influence individual transmission risk. Measurement of structural syndemic conditions would bolster a case for testing interaction effects among the syndemic conditions to enable an understanding of how variables at multiple levels exacerbate HIV health outcomes [80,81].…”

Introduction to the Special Section on Social and Behavioral Science with Gay and Bisexual Men in the Era of Biomedical Prevention

“…In addition to these articles focused on characterizing the PrEP cascade, several articles aimed to examine predictors of certain steps in the PrEP cascade. Blashill et al (2019) explored the association between syndemics (i.e., multiple co-occurring epidemics related to HIV risk) and the PrEP cascade among young Latino gay and bisexual men in southern California. This study found that as the number of self-reported syndemic indicators increased (e.g., depression, substance use), the odds of engagement in all steps of the PrEP cascade decreased.…”