Department of Epidemiology, Emory University, Atlanta, GA, USA.
Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, USA.
J Int AIDS Soc. 2020 Mar;23(3):e25461. doi: 10.1002/jia2.25461.
INTRODUCTION: Pre-exposure prophylaxis (PrEP) is a key HIV prevention technology, and is a pillar of a comprehensive HIV prevention approach for men who have sex with men (MSM). Because there have been no national data to characterize trends in the PrEP continuum in the United States, overall and for key demographic groups of MSM, we aimed to describe the extent to which PrEP awareness, willingness and use changed over time, overall and for specific groups of MSM critical for HIV prevention (e.g. Black and Hispanic MSM, younger MSM, MSM in rural areas and MSM without health coverage). METHODS: The American Men's Internet Survey (AMIS) is an annual survey of US MSM conducted in the United States among MSM aged ≥15 years since 2013. We analysed data on trends in elements of the PrEP continuum (awareness, willingness and use of PrEP) in a sample of 37,476 HIV-negative/unknown status MSM from December 2013 through November 2017. We evaluated trends in continuum steps overall and among demographic subgroups using Poisson models with Generalized Estimating Equations. For 2017 data, we used logistic regression to compare the prevalence of PrEP use among demographic groups. RESULTS: Overall, 51.4% (n = 19,244) of AMIS respondents were PrEP-eligible across study years. Between 2013 and 2017, PrEP awareness increased from 47.4% to 80.6% willingness to use PrEP increased from 43.9% to 59.5% and PrEP use in the past 12 months increased from 1.7% to 19.9%. In 2017, use of PrEP was lower for men who were younger, lived outside of urban areas, and lacked health insurance; PrEP use was not different among Black, Hispanic and white MSM. CONCLUSIONS: Our data show progress in use of PrEP among US MSM, but also reveal mismatches between PrEP use and epidemic need. We call for additional support of PrEP initiation, especially among young, non-urban and uninsured MSM. Black and Hispanic MSM report levels of PrEP use no different from white MSM, but given higher HIV incidence for Black and Hispanic MSM, parity in use is not sufficient for epidemic control or health equity.
简介：暴露前预防（PrEP）是一种关键的艾滋病预防技术，是男男性行为者（MSM）综合艾滋病预防方法的一个支柱。由于美国没有全国性的数据来描述 PrEP 连续体的趋势，因此我们旨在描述 PrEP 意识、意愿和使用随时间的变化情况，包括总体情况以及对艾滋病预防至关重要的 MSM 特定群体（例如，黑人和西班牙裔 MSM、年轻 MSM、农村地区的 MSM 和没有医疗保险的 MSM）。 方法：美国男性互联网调查（AMIS）是自 2013 年以来在美国每年对年龄≥15 岁的美国 MSM 进行的一项调查。我们分析了 2013 年 12 月至 2017 年 11 月期间，来自 37476 名 HIV 阴性/未知状态的 MSM 样本中 PrEP 连续体（意识、使用 PrEP 的意愿和使用 PrEP）各个方面的趋势数据。我们使用泊松模型和广义估计方程评估了各个连续体步骤的趋势，包括人口统计学亚组。对于 2017 年的数据，我们使用逻辑回归比较了不同人口统计学群体中 PrEP 使用的流行率。 结果：总体而言，在整个研究期间，51.4%（n=19244）的 AMIS 受访者符合 PrEP 条件。2013 年至 2017 年间，PrEP 意识从 47.4%增加到 80.6%，愿意使用 PrEP 的比例从 43.9%增加到 59.5%，过去 12 个月内使用 PrEP 的比例从 1.7%增加到 19.9%。2017 年，年轻、居住在城市以外地区和没有医疗保险的男性使用 PrEP 的比例较低；黑人和西班牙裔 MSM 与白人 MSM 之间的 PrEP 使用情况没有差异。 结论：我们的数据表明，美国 MSM 使用 PrEP 的情况有所改善，但也揭示了 PrEP 使用与流行需求之间的不匹配。我们呼吁为 PrEP 的启动提供更多支持，特别是针对年轻、非城市和没有医疗保险的 MSM。黑人和西班牙裔 MSM 报告的 PrEP 使用水平与白人 MSM 没有差异，但鉴于黑人和西班牙裔 MSM 的 HIV 发病率较高，使用情况均等不足以控制疫情或实现健康公平。
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