Pre-Exposure Prophylaxis (PrEP) Uptake among Black Men Who Have Sex with Men (BMSM) in the Southern U.S.

Oluwafemi Adeagbo,Xiaoming Li,Sayward Harrison,Shan Qiao

doi:10.3390/ijerph18189715

Abstract

Black men who have sex with men (BMSM) living in the United States (U.S.) South are disproportionately affected by HIV and experience significant disparities in HIV incidence, access to HIV care, and prevention across ages and socio-economic statuses. The aim of this commentary is to critically review current literature on the state of PrEP use among BMSM in the U.S. South, including identifying barriers and facilitators to PrEP use in order to inform intervention development. Extant literature shows that despite the documented benefits of PrEP as an effective HIV-prevention method, its uptake among BMSM is limited across the U.S. South. Common barriers to PrEP uptake included stigma, homophobia, mistrust of healthcare systems, negative attitudes from healthcare providers, access and transportation issues, poverty, and misinformation about PrEP. These barriers are likely to have been further exacerbated by the COVID-19 pandemic. Limited access to PrEP and other HIV-prevention programs, such as HIV testing, post-exposure prophylaxis (PEP), and condoms for BMSM are likely increase HIV incidence in this community. Moreover, the rapid expansion of telehealth services during the COVID-19 period may offer increased opportunity to scale-up PrEP through telehealth interventions, especially if in-person services remain limited due to pandemic precautions. Given the intersectional barriers that limit the access and uptake of PrEP among BMSM, we suggest that tailored programs or interventions that seek to address PrEP disparities among Southern BMSM should adopt intersectional and interdisciplinary approaches to better understand the complex challenges of scaling up PrEP. More studies are needed to investigate the impact of COVID-19 on HIV-prevention services among BMSM and to understand how to co-develop—with the BMSM community and healthcare providers—culturally acceptable interventions to reduce the identified challenges using intersectional and interdisciplinary approaches.

Highlights

Diagnoses in the U.S in 2019, 69% were among men who have sex with men (MSM), and 37% were among Black men who have sex with men (BMSM) [10]
Black MSM living in Southern states are less likely to be tested for HIV; if HIV-positive, they are less likely to initiate antiretroviral treatment (ART), be retained in care, and achieve an undetectable viral load when compared to White
BMSM are disadvantaged within the health systems and underrepresented in HIV-related research

Summary

Introduction

The EHE initiative prioritizes wider pre-exposure prophylaxis (PrEP) coverage, especially among populations at higher risk of HIV, including Black men who have sex with men. A meta-analysis that compared disparities and risks of HIV infection among MSM in the U.S, United Kingdom, and Canada found greater poverty and lower rates of health insurance among BMSM in the U.S than in the UK and Canada [9]. Of the estimated 36,801 new HIV diagnoses in the U.S in 2019, 69% were among men who have sex with men (MSM), and 37% were among BMSM [10]. Black MSM living in Southern states are less likely to be tested for HIV; if HIV-positive, they are less likely to initiate antiretroviral treatment (ART), be retained in care, and achieve an undetectable viral load when compared to White. Despite the benefits of PrEP, evidence indicates there is poor uptake of PrEP across the U.S, especially among BMSM [3,5,7,14,15]

BMSM PrEP Uptake in the South

Impact of COVID-19 on Uptake and PrEP-related Research among BMSM

Findings

Conclusions and Key Recommendations