According to the United States Center for Disease Control and Prevention’s Morbidity and Mortality Weekly, preliminary data from 2017 show that gay, bisexual, and other men who have sex with men (MSM) accounted for 67% of new diagnoses of HIV infections. In addition, MSM who inject drugs accounted for another 3% of new infections, and African American/black and Hispanic/Latino MSM were disproportionately affected.
To meet the goal of a 90% reduction in new infections in 10 years, the Ending the HIV Epidemic national initiative is including efforts to increase pre-exposure prophylaxis (PrEP) use. In 20 urban areas, PrEP awareness among MSM increased from 60% to 90%, and PrEP use from 6% to 35%, between 2014 and 2017.
However, an analysis of the 2017 National HIV Behavioral Surveillance (NHBS) data found that in 2017, “a lower percentage of black and Hispanic MSM than white MSM were aware of, had discussed with a health care provider, or had used PrEP.” This finding highlighted the need to address the racial/ethnic disparities in PrEP awareness, discussions with healthcare providers, and importantly, use among MSM.
Results of interviews with 10,104 sexually active MSM demonstrated that 95% of white men compared with 87% and 86% of Hispanic and black men, respectively, were aware of PrEP. However, 58%, 44%, and 43% of white, Hispanic, and black men, respectively, reported discussing PrEP with a healthcare provider. Moreover, 42% of white men reported receiving treatment with PrEP in the previous 1 year compared with 30% and 26% of Hispanic and black men, respectively. This disparity between white and black men persisted when the data were stratified for those who had health insurance and those who had a usual source of healthcare, which are typical barriers to accessing prescription medication.
The investigators listed several limitations to the findings of the report, including the fact that the NHBS uses a 12-month period for assessing risk behaviors, whereas clinical guidelines use a 6-month period. The NHBS is also not nationally representative. The data were also not weighted to account for the complex sampling methods used to recruit MSM and data on self-reported behaviors may be subject to biases. Finally, the NHBS does not collect data on renal function, and persons with abnormal renal function are considered to have contraindication to PrEP use.
According to this report, in 2017, “the disparities along the HIV PrEP continuum of care among black, Hispanic, and white MSM emerged at the point of discussion with a health care provider.” Therefore, interventions need to include both patients and healthcare providers. The authors further acknowledged that there exist social, structural, and epidemiologic determinants of racial/ethnic health disparities that must also be considered when designing intervention strategies.
Kanny D, Jeffries WL 4th, Chapin-Bardales J, et al. Racial/ethnic disparities in HIV preexposure prophylaxis among men who have sex with men – 23 urban areas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:801-806.