There is a considerable disconnect between the demographics of individuals most at risk for HIV in Birmingham, Alabama, and those of the people who partake of services at the Southern city’s sole designated pre-exposure prophylaxis (PrEP) clinic. Black men who have sex with men (MSM) and those younger than 25 in particular make up a high proportion of new HIV cases but a low share of those receiving Truvada (tenofovir disoproxil fumarate/emtricitabine) for prevention of the virus.
Publishing their findings in the Journal of Acquired Immune Deficiency Syndromes, researchers conducted a retrospective analysis of data about those who sought services from the University of Alabama’s PrEP clinic as well as data from the Alabama Department of Public Health (ADPH) HIV Surveillance System. They compared demographic factors between those attending the PrEP clinic and individuals diagnosed with HIV in the area in 2014.
This PrEP clinic, according to the published paper, is “the only location in Birmingham providing PrEP as part of comprehensive HIV prevention services.”
Between March 2014 and February 2016, the clinic screened 120 people for PrEP services. Eighty-four percent of them were men, 80 percent were MSM, 44 percent were in a relationship with an HIV-positive partner, 27 percent were Black, 18 percent were Black MSM, 8 percent were Black MSM younger than 25, 86 percent reported having condomless sex, 34 percent were referred to the clinic by a sex partner and 79 percent had health insurance.
In Jefferson County, which includes Birmingham, 159 people were newly diagnosed with HIV in 2014. Seventy-nine of these diagnoses were among African Americans, 84 percent were among men, 62 percent were among MSM and 50 percent were among Black MSM. Among the 80 cases diagnosed among Black MSM, 30 (38 percent) were among those younger than 25 (who made up 19 percent of all new diagnoses).
Comparing the demographics between the two data sets, the study authors found statistically significant disparities (meaning these differences did not likely occur by chance) according to multiple factors. The PrEP clinic screened a smaller proportion of the following demographics compared with those demographics’ share of new diagnoses in Jefferson County: Black individuals, who made up 27 percent of those screened versus 79 percent of those diagnosed with HIV; Black MSM, 18 percent versus 50 percent; Black men who have sex with women, 2 percent versus 15 percent; Black women, 7 percent versus 13 percent, and Black MSM younger than 25, 8 percent versus 19 percent.
Of the 120 people screened at the clinic, 63 (53 percent) remained on PrEP as of the paper’s writing—58 percent of them were white and 80 percent were MSM.
The study authors concluded that their “data indicate that patients initially accessing PrEP clinic services are not necessarily the populations most greatly affected by the HIV epidemic in our community.”
Additionally, the investigators wrote: “The current study highlights the need for more demonstration projects in Southern communities, because if similar patterns for PrEP uptake are seen in other Southern states exacerbation of HIV health disparities may be seen in this region of the country.”
To read the study, click here.