Abstract
PurposeIn the United States (U.S.), southern states have the highest HIV incidence. Uptake of pre-exposure prophylaxis (PrEP) has been slow among Black people, particularly in the South. We know little about how area-level HIV risk influences one's willingness to use PrEP. Methods169 Black participants across 142 ZIP codes in the South completed the 2016 National Survey on HIV in the Black Community. We performed log-binomial regression to estimate the prevalence risk associated with residing in the upper 25th percentile of increases in new HIV diagnosis (2014–2015) within ZIP code and an individual's willingness to use PrEP, adjusting for individual and area-level covariates. ResultsParticipants were 68% female, mean age of 36 years, and 24% willing to use PrEP. Among the ZIP codes, 23% were within Atlanta, GA. The median increase in new HIV diagnoses was 25 per 100,000 population from 2014 to 2015 (IQR, 14–49). Participants living in ZIP codes within the upper 25th (compared-to-lower 75th) percentile of new HIV diagnoses were more willing to use PrEP (adjusted prevalence ratio (aPR) = 2.02, 95% CI = 1.06–3.86, P = .03). Area-level socioeconomic factors attenuated that association (aPR = 1.63, 95% CI = 0.78–3.39, P = .19). ConclusionsArea-level factors may influence PrEP uptake among Black people in the South.
Highlights
Pre-exposure prophylaxis (PrEP) is a highly effective means of preventing HIV infection [1]
Descriptives—We developed a geographic map of the distribution of 2016 NSHBC participants by ZIP code, and we included a map of Black people living with HIV in 2015, which we obtained directly from AIDSVu [37]
Twenty-three percent of participants resided in ZIP codes from Atlanta, GA, and six-and-a-half percent were from Fort Lauderdale, FL, and Hampton Roads, VA
Summary
Pre-exposure prophylaxis (PrEP) is a highly effective means of preventing HIV infection [1]. Uptake of PrEP in the U.S general population is low; approximately 8% of eligible persons are actively using PrEP [2] higher among men who have sex with men (MSM) at 35% [5]. According to a 2018 Centers for Disease Control and Prevention (CDC) report, only 1% of eligible Black people were prescribed PrEP [2]. The social determinants of low PrEP uptake among Black people have not been well described. Part of the reason for the paucity of SDOH studies in PrEP willingness and uptake is because determining which of the numerous SDOH factors to study and intervene on is complex and dependent on the health or behavioral issue, target audience (e.g., adolescents, immigrants, Black people) and whether one has an emic perspective of the situation if they are part of the target group [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
