Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, yet has been underutilized. Since 2012, the New York City (NYC) Department of Health and its partners have launched programs to support PrEP uptake. Using data from routine behavioral surveillance among men who have sex with men (MSM), we examined recent trends and associations with PrEP use.
Data were derived from annual surveys conducted in-person and online, 2013-2015. Eligible respondents were NYC residents, who were born male, aged 18-40, and reported anal sex with a man (past 6 months). This analysis excluded those who reported being diagnosed with HIV. PrEP use was defined as use in the past 6 months. Demographic factors examined included age (18-29/30-40 years), race/ethnicity (black/Hispanic/white/other), education (college degree) and insurance status. Behavioral factors were condomless sex or known HIV-positive partner at last sexual encounter and number of condomless partners (3 or more) and/or post-exposure prophylaxis (PEP) use in the past 6 months. Using logistic regression, we assessed associations between PrEP use and year, factors, and year-factor interaction terms. Those associated bivariately (p<0.05) were added to a multivariate model with age, race/ethnicity, insurance, survey type (in-person/online) and year.
Among 1595 respondents, the majority were aged 18-29 (63%), black (24%) or Hispanic (32%), educated (60% had a college degree or higher) and insured (83%). Report of PrEP use was 2.1%, 3.2% and 14.8% in 2013, 2014 and 2015; this increase was significant in the multivariate model (p<0.001). Among demographic factors examined, only being insured was bivariately associated with PrEP use (OR 2.5, CI 1.1-5.5); it was not significant in the multivariate model. PrEP use was associated with condomless sex (adjusted odds ratio (aOR) 3.8, 95% confidence interval (CI) 2.4-6.1) and sex with a known HIV-positive partner (aOR 3.0, CI 1.3-6.8) at the last encounter; and ≥3 condomless partners (aOR 2.8, CI 1.8-4.4) and PEP use (aOR 26.9, CI 12.8-56.3) in the past 6 months. None of the associations with PrEP differed by year (interaction term p>0.05).
Findings suggest PrEP use is increasing among MSM in NYC. Use appears to be greater among those with higher behavioral risk, consistent with recommendations. The association of use with insurance status underscores the importance of addressing financial barriers. Monitoring for disparities will be critical as PrEP use increases.