Abstract Body

The US Food and Drug Administration (FDA) approved the first drug for daily HIV pre-exposure prophylaxis (PrEP) use in 2012. Subsequent to FDA approval, efforts have been made to raise awareness and use of HIV PrEP among men who have sex with men (MSM) and those who are at increased risk for acquiring HIV infection. We evaluated changes in PrEP awareness and use among MSM in the US overall and by race between 2014 and 2017 using National HIV Behavioral Surveillance (NHBS) data from 20 U.S. cities.

Men were recruited at events frequented by MSM in each city using venue-based sampling. We used log-linked poisson regression models with generalized estimating equations clustered on event to estimate the prevalence ratios (PR) and 95% confidence intervals (CI) for PrEP awareness and use, adjusted for income and health insurance. Analyses were limited to HIV-negative men who reported substantial risk for HIV infection consistent with PrEP indications (had either a male sex partner who was not known to be HIV negative or >1 male sex partner in the past 12 months and had either a sexually transmitted infection or condomless anal sex with a male partner also in the 12-month period).

We analyzed data from 3,978 MSM at substantial risk for HIV infection who were interviewed in 2014 and 4,182 who were interviewed in 2017. Between 2014 and 2017, PrEP awareness increased overall from 59% to 90% (adjusted PR (aPR) 1.14, CI: 1.13-1.16) and PrEP use increased from 5% to 34% (aPR 1.80, CI: 1.72-1.90). Both awareness and use increased in all racial and age groups. However, PrEP awareness was lower among black (85%; aPR 0.94, CI: 0.90-0.98) and Hispanic men (85%; aPR 0.92, CI: 0.89-0.96) than white men (94%). In 2017, PrEP use among men at substantial risk was lower among black (26%; aPR 0.71, CI: 0.60 – 0.84) and Hispanic men (29%; aPR 0.79, CI: 0.68 – 0.93) compared with white men (42%).

From 2014 to 2017 PrEP use increased over 500% among MSM who are at substantial risk for HIV infection. PrEP awareness also increased significantly. However, PrEP use remains low, especially among black and Hispanic men. Efforts to raise PrEP use among black and Hispanic men may help reduce HIV disparities in the US.