JMIR Publications

ABSTRACT

Background:

HIV disproportionately affects sexual minority men (SMM) in the U.S.

Objective:

We sought to determine past HIV post-exposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among an online 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 online venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use on PEP and PrEP use, as well as the association between past PEP use on current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at p < 0.001 given the large sample size; 99.9% confidence intervals are reported.

Results:

Prior PEP use was reported by 11.3% of participants, with current or prior PrEP use reported by 22.0% and 8.1%, respectively. Nearly half (46.0%) of past PEP users were current PrEP users, and another 39.9% of participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (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 to white men, Black men had higher prevalence of past PEP use and current PrEP use, Latinx men had higher prevalence of PEP use but no significant difference in PrEP use, and those considered of another race/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 those in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race/ethnicity by past PEP use on current PrEP use was found (RRR = 0.57; 99.9% CI: 0.37-0.87), indicating 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 compared to those without recent use.

Conclusions:

PrEP use continues to be the predominate HIV prevention strategy for SMM compared to PEP, but many current PrEP users had previously used PEP for HIV prevention. Higher rates of past PEP use and current PrEP use among Black SMM is noteworthy given disproportionate burden of HIV. Nonetheless, understanding the disconnect linking PEP users to PrEP among Black SMM is an important avenue for future research. Further efforts are also needed to increase PrEP use among Latinx SMM given increasing disparity between Latinx and white SMM in the U.S.