Although HIV pre-exposure prophylaxis (PrEP) awareness and use increased from 2014 to 2017, increases in both areas are needed to reduce new HIV infections by 2030, specifically in high-risk patients, according to a report published in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.
In 2019, a strategic initiative was proposed by the United States Department of Health and Human Services with the goal of ending the HIV epidemic by reducing incident infections by 90% during 2020 to 2030 in the United States. One focus of the initiative was protecting individuals at risk for HIV infection using proven, comprehensive prevention approaches and treatments such as PrEP. However, PrEP use remains low among men who have sex with men (MSM), and this is more pronounced among black and Hispanic MSM. Therefore, continued efforts to improve covered are needed to reach the goal by 2030.[CM1]
The Centers for Disease Control and Prevention’s National HIV Behavioral Surveillance staff collected cross-sectional behavioral survey data and conducted HIV testing among MSM in 20 urban areas in the United States between 2014 and 2017. Over this period, 18,610 men, aged ≥18 years who reported having ever had oral or anal sex with another man were offered incentives for an anonymous HIV test and asked to complete a standardized questionnaire. This analysis was limited to MSM who had a negative National HIV Behavioral Surveillance HIV test result, did not report a previous HIV-positive test result, had either 1 male sex partner who was HIV positive or 2 or more male sex partners in the past 12 months, and reported either condomless anal sex or a bacterial sexually transmitted infection in the past 12 months.
Of the 18,610 MSM interviewed, 7873 (42%) had a negative HIV test result and were included in this analysis. Awareness of PrEP among this population increased from 60% in 2014 to 90% in 2017 in both the study cohort overall and in all subgroups and urban areas. Researchers noted that in 2017, >80% of MSM, across all demographics, were aware of PrEP. Overall rates of PrEP use among MSM increased from 6% in 2014 to 36% in 2017 overall, with proportional increases demonstrated in black, Hispanic, and young (aged 18-29 years) MSM. Although the differences in PrEP use between Hispanic and white and young and older MSM were no longer significant in 2017, PrEP use between black and white patients remained significant (26% and 42%, respectively). Education and increased income were associated with increased PrEP use in 2017. Further, 39% of MSM who had seen a health provider within 12 months reported PrEP use.
Although PrEP use by MSM increased approximately 500% from 2014 to 2017 in this analysis, only 1 in 3 men at risk for HIV infection reported using PrEP, highlighting that higher coverage is needed. To increase PrEP use, healthcare providers might need training and resources to ensure they know how to assess their patients for indications for PrEP and are confident discussing PrEP medication. Overall, the study authors concluded that, “By routinely testing patients for HIV, assessing HIV-negative patients for risk behaviors, and prescribing PrEP as needed, health care providers can play a critical role in ending the HIV epidemic.”
Finlayson T, Cha S, Xia M, et al. Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men – 20 urban areas, 2014 and 2017. MMWR Morb Mortal Wkly Rep. 2019;68:597-603.