Although the CDC estimates that >400,000 U.S. men who have sex with men (MSM) are PrEP candidates, uptake initially was slow. Monitoring recent trends is important to ensure wider access to those at greatest HIV risk.
An on-line survey was mounted on 2 popular MSM partner seeking sites during March 2016 to assess PrEP use. Factors independently associated with PrEP use were evaluated using multivariable logistic regression with backward selection.
Of 4,698 MSM respondents, 21% were 18 to 24 y.o., 41% were 25 to 39, and 38% were 40 or older. Almost half (47%) identified as White, 25% as Black, 11% as Latino. Almost 12% were born outside the U.S. The largest number of respondents were from the Southeast (26%) or Mid-Atlantic (20%). Nearly 60% had private health insurance; 12% had none. Almost 2/3 reported condomless anal intercourse (C.A.I.) at least once in the prior 3 months. Bacterial STIs were common (8% reporting gonorrhea, 8% chlamydia, and 6% syphilis in the prior year). Almost 8% had used PEP previously. Almost 15% of respondents (N=684) reported using PrEP. PrEP users resided in 45 different states, 491 zipcodes. Factors independently associated with PrEP use in a multivariable model depicted by aOR and (95% CI) were: Age over 25 years: 1.9 (1.3, 2.7) (REF: 18-24 years old) Black race: 0.7 (0.6, 0.9) (REF: White) Born outside US: 0.7 (0.4, 0.9) (REF: native-born) Private insurance: 3.8 (2.4, 6.0) (REF: No insurance) Urban zip code: 1.02 (1.01, 1.02) (REF: non-urban zipcode) 2 or more CAI acts*: 2.9 (2.2, 3.8) (REF: 0 CAI) (*in past 3 months) Bacterial STI**: 3.1 (2.4, 3.9) (REF: no STI) (** in past year) Ever used PEP: 6.5 (4.7, 9.0) (REF: no prior PEP use)
In this online MSM sample, those who engaged in condomless anal sex with non-monogamous partners, who had a bacterial STI and/or had used PEP were more likely to report PrEP use. Those who were younger, Black, immigrant and/or uninsured MSM were less likely to report PrEP use, despite frequent condomless anal sex. Programs to address economic and sociodemographic disparities are needed to ensure wider PrEP access to those who might benefit most.