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- MSM
- antiretroviral medication
- PrEP
- education
- sexual behaviour
- homosexual
- substance misuse
- HIV
- HIV testing
- HIV clinical care
Pre-exposure prophylaxis (PrEP) of HIV infection with antiretroviral therapy (ART) was recently found to reduce HIV infection through sexual contact in men who have sex with men (MSM).1 Non-prescribed use and sharing of ART to prevent HIV infection were reported by MSM in the USA before efficacy was determined.2 We report on demographic factors associated with ART use for prophylaxis purposes prior to known efficacy.
A convenience sample of MSM was enrolled in Chicago, Los Angeles, New York City and San Francisco.2 3 We assessed pre-efficacy use of ART medications by HIV-negative MSM (n=454) and sharing of ART medications by HIV-positive MSM (n=557) with their sex partners for use ‘before sex’ (PrEP) and ‘after sex’ (post-exposure prophylaxis, PEP) to prevent HIV infection. Demographic characteristics included: 22% 18–29 years, 35% 30–39 years and 43% 40+ years old; 33% black, 18% Hispanic, 38% white and 11% other race/ethnicity; and 31% high school equivalency or less, 34% some post-high school education and 35% college degree or more education.
HIV-negative men with a high school diploma/equivalency or less (‘less education’) were more likely than others to report using PrEP (5% vs 1%, p<0.05) and PEP (8% vs 3%, p<0.05) in the prior 6 months. In multivariate analysis adjusting for age, race/ethnicity and city, ‘less education’ was associated with recent use of PEP (OR=3.5, 95% CI=1.1 to 11.8) but not PrEP (p>0.05) compared with those with at least a college degree; none of the other demographic variables was associated with PrEP or PEP use (p>0.05) by HIV-negative men.
HIV-positive men with ‘less education’ were more likely to report sharing ART with sex partners for the purpose of PrEP (6% vs 1%, p<0.05) and PEP (8% vs 2%, p<0.05) in the prior 6 months. Other bivariate associations were 30–39 years of age compared with younger men (6% vs 0%, p<0.05) and older men (6% vs 2%, p<0.05), and black compared with all other race/ethnicities (5% vs 1%, p<0.05); black men were also more likely to share ART for PEP (7% vs 2%, p<0.05). In multivariate analysis, no variables were associated (p>0.05) with sharing ART for PrEP use; ‘less education’ was linked to sharing for PEP use, compared with men with some post-high school education (OR=2.7, CI=1.0 to 7.2 (p=0.05)) or a college degree or more education (OR=9.3, CI=1.1 to 76.9).
Research is needed in an era of known efficacy,1 including assessment of PrEP awareness, access, uptake and adherence. A measurement limitation is that continuous PrEP and PEP use may become one, although intent of PEP or PrEP use can still be assessed. Other scientific questions remain,4 5 including how to best triage and message for maximum benefit with multiple efficacious interventions (ie, condoms, PrEP). Non-prescribed use of ART for prophylaxis should be monitored.
Acknowledgments
The authors thank the study participants and staff. Project MIX Study Team: Atlanta—Steve Flores, Gordon Mansergh, David Purcell, Pilgrim Spikes, Raekiela Taylor; Chicago—Kellie Dyslan, Carol Ferro, David Jamenez, Jenny Hopwood, Nicole Martin, David McKirnan, Chris Powers, Pedro Rodriguez; Los Angeles—John Copeland, Lawrence Fernandez Jr, Bobby Gatson, Sharon Hudson; New York—John Bonelli, Sebastian Bonner, Kent Curtis, Victoria Frye, Krista Goodman, Donald Hoover, Beryl Koblin; San Francisco—Grant Colfax, Rob Guzman, Tim Matheson.
Footnotes
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Competing interests None.
Ethics approval This study was approved by the CDC Institutional Review Board (#3985) and the local ethics boards at each study site institution.
Provenance and peer review Not commissioned; internally peer reviewed.