Eliminating racial HIV disparities among MSM will require a greater uptake of HIV prevention interventions among Black MSM (BMSM), the group with the highest HIV incidence in the US. However, interventions such as PrEP necessitate engagement in a health care system that often does not meet the needs of BMSM. This study examined correlates of the uptake of HIV prevention interventions among BMSM.
We interviewed two non-clinic-based samples of BMSM in Washington, DC: (1) peer-referred men who were inadequately engaged in health care and/or reported barriers to care (n=75) and (2) an Internet-based sample recruited irrespective of health care characteristics (n=93). Participants reported on their uptake of HIV prevention interventions in a computer-assisted self-interview. A randomly selected subsample of those with barriers to care provided ethnographic data on health care experiences in a qualitative interview (n=30). Correlates of uptake of interventions were assessed using Chi-square tests.
Of 168 total BMSM, 61% were <30 years old, 86% had health insurance, and 81% were HIV-negative, 54% of whom were offered an HIV test at their last health care visit. Among HIV-negative BMSM in the first sample with barriers to care, a higher proportion of those who sought care at community-based clinics received HIV prevention interventions (testing, counseling, or PrEP) at these visits (90%) compared to those who accessed primary (53%) or acute care (44%) settings (p=0.005). In the Internet-based sample, PrEP uptake was positively associated with having accessed a community-based clinic but not a primary or acute care setting in the last year (OR= 4.7; 95% CI: 1.6-13.9), and was negatively associated with having private health insurance (OR=0.23; 95% CI: 0.08-0.92). In qualitative interviews, BMSM expressed preferences for receiving interventions at community-based clinics that were known to have culturally competent providers despite also often having access to private primary care providers.
In a non-clinic-based sample of BMSM, reported uptake of HIV prevention interventions was highest in community-based clinics that were culturally sensitive to the unique health needs of BMSM. Having access to health insurance and to health care does not necessarily facilitate the uptake of HIV prevention interventions for BMSM. It is critical that all health care encounters regardless of the setting support the uptake of prevention interventions for those at highest risk of HIV.