As the use of condoms has declined among Latino men who have sex with men (MSM) in recent years, rising pre-exposure prophylaxis (PrEP) use might have offset this shift’s effect on the men’s HIV risk, in particular among those born in the United States. That is according to a new Centers for Disease Control and Prevention (CDC) report on HIV risk among Latino MSM, published in the Morbidity and Mortality Weekly Report.
Previous CDC surveillance has indicated that among MSM as a whole, Latinos constitute the only major race category for which the rate of HIV acquisition has been rising. Between 2008 and 2015, annual new cases of the virus increased by an estimated 25% in this demographic, while remaining stable among Black MSM and declining among their white counterparts.
In their new analysis, CDC researchers analyzed data on sexually active HIV-negative Latino MSM who responded to the National HIV Behavioral Surveillance (NHBS) survey in 2011, 2014 and 2017. The survey recruits MSM at public venues in 19 urban areas.
The population surveyed was not nationally representative, so any figures in the report cannot be generalized to reflect all Latinos. However, there remains much to learn from the trends the report identifies about how HIV-risk-related sexual behavior has changed over time and how it differs among subgroups.
The men who participated in the survey were asked whether they had used PrEP or had anal sex without a condom at any time during the previous 12 months. The report defined unprotected sex as a man having reported that during the previous 12 months he had had condomless sex but had not used PrEP. Given that during the previous year men may have used PrEP for a period that did not overlap with any times they had condomless sex, the report may have overestimated how much the men were protected by PrEP.
Truvada (tenofovir disoproxil fumarate/emtricitabine) was first approved as PrEP in 2012, so the 2011 survey did not ask about PrEP use.
The analysis included 4,731 Latino MSM, including 1,581 in 2011, 1,479 in 2014 and 1,671 in 2017.
The proportion of men reporting any condomless sex during the previous 12 months increased from 63% in 2011 to 74% in 2017.
Any PrEP use during the previous 12 months was reported by 3% of the men in 2014 and 24% in 2017. In 2017, PrEP use was reported by 28% (283 of 1,024) of U.S.-born men; 19% (87 of 457) of non-U.S.–born men who had been in the United states for six years or longer; and 16% (30 of 188) of non-U.S.–born men who had been in the United States for less than six years.
After adjusting the data to account for the men’s age and the region in which they lived, the study authors found that the men’s overall rate of reported condomless sex increased by 7% between 2011 and 2014 and by 6% between 2014 and 2017. This compared with respective increases of 13% and 10% among men not born in the United States who had lived in the country for at least six years.
The prevalence of unprotected sex decreased between 2014 and 2017 in all subgroups of survey respondents. The largest decrease, 26%, was seen among those born in the United States.
In 2017, the proportion of each subgroup reporting condomless anal sex during the previous year was similar in all subgroups—nearly 75%. But when it came to unprotected sex, fewer U.S.-born men fell into this category, at 49%, than non-U.S.–born men, among whom 58% of those living in the United States for at least six years and 59% of those living in the country for less time were in this category.
“Recent [Latino MSM] residents,” the CDC suggested, “might benefit from improved HIV prevention education and services, including access to PrEP and condoms. Further, non-U.S.–born Hispanic/Latino MSM, regardless of duration of U.S. residence, might encounter more barriers to PrEP use than do their U.S.-born counterparts.”
The report proposed greater efforts to provide Latino MSM with culturally competent PrEP-related materials in Spanish.
To read the CDC report, click here.