Health Intervention Sciences Group / Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
Department of Psychology, Hunter College of the City University of New York, New York, NY, United States.
JMIR Public Health Surveill. 2022 Dec 16;8(12):e31237. doi: 10.2196/31237.
BACKGROUND: HIV disproportionately affects sexual minority men (SMM) in the United States. OBJECTIVE: We sought to determine past HIV postexposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among a web-based sample of cisgender and transgender men who have sex with men. METHODS: In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other web-based venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP use and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use with PEP and PrEP use, as well as the association between past PEP use and current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at P<.001, given the large sample size; 99.9% CIs are reported. RESULTS: Prior PEP use was reported by 11.28% (7108/63,015) of the participants, with current or prior PrEP use reported by 21.95% (13,832/63,015) and 8.12% (5118/63,015), respectively. Nearly half (3268/7108, 46%) of the past PEP users were current PrEP users, and another 39.9% (2836/7108) of the participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (relative risk ratio [RRR] 23.53, 99.9% CI 14.03-39.46) and prior PrEP use (RRR 52.14, 99.9% CI 29.39-92.50). Compared with White men, Black men had higher prevalence of past PEP use and current PrEP use, Latino men had higher prevalence of PEP use but no significant difference in PrEP use, and those identifying as another race or ethnicity reported higher prevalence of past PEP use and lower current PrEP use. Past PEP use and current PrEP use were highest in the Northeast, with participants in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race by past PEP use with current PrEP use was found (RRR 0.57, 99.9% CI 0.37-0.87), indicating that Black men who previously used PEP were less likely to report current PrEP use. Participants who reported recent club drug use were significantly more likely to report past PEP use and current or prior PrEP use than those without recent club drug use. CONCLUSIONS: PrEP use continues to be the predominant HIV prevention strategy for SMM compared with PEP use. Higher rates of past PEP use and current PrEP use among Black SMM are noteworthy, given the disproportionate burden of HIV. Nonetheless, understanding why Black men who previously used PEP are less likely to report current PrEP use is an important avenue for future research.
背景:艾滋病毒在美国不成比例地影响着性少数群体男性(SMM)。
目的:我们旨在确定在基于网络的男男性接触者样本中,过去是否使用过艾滋病毒暴露后预防(PEP)以及当前和既往使用过暴露前预防(PrEP)。
方法:2019 年,通过地理位置社交网络应用程序、社交媒体和其他基于网络的场所,招募了 HIV 阴性和未知状态的 SMM(n=63015),以参与简短的资格筛选调查。询问了个人过去 PEP 使用情况以及当前和既往 PrEP 使用情况。我们检查了人口统计学、社会经济指标和最近使用俱乐部药物与 PEP 和 PrEP 使用之间的关联,以及过去 PEP 使用与当前和既往 PrEP 使用之间的关联,使用了广义线性模型和多项逻辑回归。考虑到样本量很大,统计意义被认为在 P<.001 水平;报告了 99.9%的置信区间。
结果:有 11.28%(7108/63015)的参与者报告了既往 PEP 使用,当前或既往 PrEP 使用的比例分别为 21.95%(13832/63015)和 8.12%(5118/63015)。近一半(3268/7108,46%)的过去 PEP 使用者是当前 PrEP 使用者,另外 39.9%(2836/7108)的参与者报告过去 PEP 使用也报告了既往 PrEP 使用。在多变量分析中,过去 PEP 使用与当前(相对风险比[RRR] 23.53,99.9%CI 14.03-39.46)和既往 PrEP 使用(RRR 52.14,99.9%CI 29.39-92.50)相关。与白人男性相比,黑人男性过去 PEP 使用和当前 PrEP 使用的流行率更高,拉丁裔男性 PEP 使用的流行率更高,但 PrEP 使用没有显著差异,而自认为是其他种族或族裔的男性过去 PEP 使用的流行率更高,当前 PrEP 使用的流行率更低。过去 PEP 使用和当前 PrEP 使用在东北地区最高,中西部和南部地区的参与者报告的 PEP 和 PrEP 使用明显较低。发现黑人种族与过去 PEP 使用与当前 PrEP 使用之间存在显著的交互作用(RRR 0.57,99.9%CI 0.37-0.87),表明以前使用过 PEP 的黑人男性不太可能报告当前使用 PrEP。报告最近使用俱乐部药物的参与者比没有最近使用俱乐部药物的参与者更有可能报告过去 PEP 使用和当前或既往 PrEP 使用。
结论:与 PEP 使用相比,PrEP 使用仍是 SMM 预防艾滋病毒的主要策略。黑人 SMM 中过去 PEP 使用和当前 PrEP 使用的比率较高,这一点值得注意,因为他们感染艾滋病毒的负担不成比例。尽管如此,了解为什么以前使用过 PEP 的黑人男性不太可能报告当前使用 PrEP 的原因,是未来研究的一个重要途径。
Int J Environ Res Public Health. 2022-1-9
J Int Assoc Provid AIDS Care. 2020