Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 16;8(12):e31237.
doi: 10.2196/31237.

The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study

Steven A John  1 , K Marie Sizemore  2 , Ruben H Jimenez  2 , S Scott Jones  2 , Andrew E Petroll  1 , H Jonathon Rendina  2
Affiliations

The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study

Steven A John et al. JMIR Public Health Surveill. .

Abstract

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.

Keywords: HIV; men who have sex with men; postexposure prophylaxis; pre-exposure prophylaxis; sexual minority men.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: AEP receives research funding from Gilead Sciences, Inc.

References

    1. HIV surveillance report. Centers for Disease Control and Prevention. [2019-08-09]. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html .
    1. Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the prevalence of HIV and sexual behaviors among the us transgender population: a systematic review and meta-analysis, 2006-2017. Am J Public Health. 2019 Jan;109(1):e1–8. doi: 10.2105/AJPH.2018.304727. https://europepmc.org/abstract/MED/30496000 - DOI - PMC - PubMed
    1. Reisner SL, Moore CS, Asquith A, Pardee DJ, Mayer KH. The pre-exposure prophylaxis cascade in at-risk transgender men who have sex with men in the United States. LGBT Health. 2021;8(2):116–24. doi: 10.1089/lgbt.2020.0232. https://europepmc.org/abstract/MED/33567245 - DOI - PMC - PubMed
    1. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019 Mar 05;321(9):844–5. doi: 10.1001/jama.2019.1343.2724455 - DOI - PubMed
    1. FDA approves first medication to reduce HIV risk 2012. US Food and Drug Administration. 2012. Jul 16, [2018-09-06]. https://wayback.archive-it.org/7993/20170406045106/https://www.fda.gov/F... .

Publication types