After a slow start, use of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) shot up in 2015 among young New York City men who have sex with men (MSM). Evidence suggests that MSM at higher risk of HIV infection are more likely to take Truvada to prevent the virus. Researchers analyzed data from annual surveys conducted in-person and online among 1,595 New York City MSM between 2013 and 2015. Findings were presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.
The U.S. Food and Drug Administration (FDA) approved Truvada for HIV prevention in 2012. Americans were initially slow to adopt PrEP, but evidence suggests use began to pick up after considerable media attention began in the fall of 2013. New York State Medicaid data have indicated a more than four-fold increase in PrEP prescriptions covered by the public insurer between 2014 and 2015, from 303 to 1,330.
This new survey included New York City residents who were born male, were 18 to 40 years old, and reported anal sex with a man during the previous six months. The analysis excluded men who reported being diagnosed with HIV. PrEP use was defined as taking Truvada for HIV prevention during the previous six months. The study looked at the following demographic factors: age (dividing between 18-to-29-year-olds and 30-to-40-year-olds), race or ethnicity (black, Latino, white or other), education (whether or not the men had a college degree), and health insurance status.
Sixty-three percent of the men were 18-to-29-years-old, 24 percent were black, 32 percent were Latino, 36 percent were white, 60 percent had a college degree or higher, and 83 percent had health insurance.
In 2013, 2014 and 2015, the respective proportion of the respondents who reported PrEP use was 2.1 percent, 3.2 percent and 14.8 percent. These increases were statistically significant for each year, meaning it is very unlikely they occurred by chance.
The only demographic factor that was associated with PrEP use, when measuring just one demographic variable against PrEP use at a time, was insurance status: Those who had health insurance were 2.5 times more likely to report PrEP use. However, when the researchers adjusted the data for multiple demographic variables at once, this association was no longer statistically significant.
According to the analysis that adjusted the data for multiple variables, reporting condomless sex during the previous six months was associated with a 3.8-fold greater likelihood of PrEP use, while reporting that the last sexual encounter was with an HIV-positive man, reporting condomless sex with at least three partners during the previous six months, and reporting post-exposure prophylaxis (PEP) use during the previous six months were associated with a respective 3-fold, 2.8-fold and 26.9-fold increased likelihood of reporting PrEP use. These associations did not differ by the year of the study.
To read the conference abstract and poster, click here.