HIV RISK FACTORS ASSOCIATED WITH THE PRE-EXPOSURE PROPHYLAXIS CASCADE AMONG YOUNG AND ADULT BLACK MEN WHO HAVE SEX WITH MEN IN BALTIMORE CITY

• Published in: Journal of adolescent health 2019-02, Vol.64 (2S), p.S44
• Main Authors: Fields, Errol L, Fennell, Christina, Wagner, Jessica, Schumacher, Christina, Chandran, Aruna, Price, Ashley, McClarin, Lavisha, Murray, Jeannie, Arrington-Sanders, Renata, Davis, Maisha, Page, Kathleen, Greenbaum, Adena, Chaulk, Patrick, Jennings, Jacky
• Format: Article
• Language: English
• Subjects: African Americans; Age differences; Anal intercourse; Health disparities; HIV; Homosexuality; Human immunodeficiency virus; Medical diagnosis; Men who have sex with men; Prescription drugs; Risk assessment; Risk factors; Sexual behavior; Sexually transmitted diseases; STD; Uptake
• ISSN: 1054-139X; 1879-1972

Purpose: Young (13-24) black men who have sex with men (YBMSM) and black MSM (BMSM) in general continue to experience HIV disparities. Pre-exposure prophylaxis (PrEP) is a potential tool for reducing these disparities especially when those at greatest risk for acquisition are prioritized for PrEP delivery. PrEP services follow a cascade similar to HIV treatment cascades with gaps at each level of delivery. The study objective was to determine significant differences by age and risk factors associated with HIV acquisition among BMSM who progressed (versus not) along the cascade of PrEP delivery in Baltimore. Methods: HIV risk factor, demographic and PrEP cascade data on BMSM from IMPACT, a CDC-funded initiative focused on increasing PrEP uptake among priority populations, were collected from September 2015 through March 2018 from seven Baltimore-area sites. HIV risk factors included STI diagnosis and number of sex partners in the past 3 months and, in the past 12 months, sex with HIV-positive partner, exchange sex, and receptive anal sex. Age was dichotomized (13-24 and 25+). PrEP cascade categories included: eligible based on risk, referred, accepted, linked, clinically eligible, prescribed, and currently on PrEP. Student t-test with unequal variance and chi-squared test were used to determine significant differences in progression at each level of the cascade by age and risk factor. Results: IMPACT encountered 826 PrEP eligible BMSM. 31% (n=256) were 13-24 (mean=21.2/SD=2.13). Significant differences in HIV risk factors were noted at most steps in the cascade. Among those referred for PrEP (356/826) versus not, there was a significantly lower proportion of those with an STI (48% versus 52%, p=0.002), a greater proportion of those with HIV-positive sex partner(s) (55.3% versus 44.7%, p