Young men who have sex with men (MSM) in California are widely aware of Truvada (tenofovir/emtricitabine) as PrEP, with one in 10 participants in a statewide survey reporting they had used the HIV prevention method as of a year ago. Considerable racial disparities surfaced in the survey, with black and Latinos much less likely than whites to report having taken PrEP. Considering black and Latino MSM are at higher risk for HIV, this finding calls into question PrEP’s potential impact in slowing overall infection trends.
Numerous data sources have shown that PrEP is catching on among MSM in the United States; the rate of new prescriptions is steadily accelerating with each passing quarter. However, use tends to be limited to older white MSM in a handful of major urban areas, and none of the high-use cities are in the hard-hit South.
The report on young MSM in California was based on an online survey conducted in July and August 2015. Considering the rapidly increasing PrEP use trends, some of the survey’s findings may already be out of date. However, the disparities seen in the data open a window into obstacles to best harnessing the power of Truvada to prevent HIV on a public health level.
Survey participants were recruited through hookup apps and websites. To participate, they needed to be 18 to 29 years old, a California resident, HIV negative and identify as a biological male.
Of the 602 participants, 40.4 percent were Latino, 32.2 percent were black and 27.4 percent were white. Seventy-three percent reported an income of $60,000 or less.
A total of 9.6 percent reported ever using PrEP, including 13.9 percent of whites, 9.8 percent of blacks and 6.6 percent of Latinos. The rate for blacks was not statistically significantly different from that of whites or Latinos, meaning differences between them could have occurred by chance.
Fourteen percent of 22- to 25-year-olds had used PrEP, compared with 9.3 percent of 26- to 29-year-olds and 3.9 percent of 18- to 21-year-olds. Thirteen percent of those with incomes of at least $30,000 had used PrEP, compared with 9.9 percent of those with lower incomes.
Seventy-three percent of the respondents were aware of PrEP, including 87.3 percent of whites, 71.8 percent of Latinos and 62.9 percent of blacks. A total of 81.4 percent of 26- to 29-year-olds were aware of PrEP, as were 78.1 percent of 22- to 25-year-olds and 59 percent of 18- to 21-year-olds. A total of 77.5 percent of those who reported having sex with only men were aware of PrEP, compared with 60.2 percent of those who reported having sex with men and women.
Of the 397 respondents who were aware of but had never taken PrEP, most had heard of PrEP through sources other than medical providers. A total of 56.7 percent had learned about it through social media, 49.4 percent online, 46.6 percent through friends, 25.9 percent from sex partners, 25.4 percent through LGBT community organizations and 25.2 percent through HIV organizations.
A total of 70.5 percent of those aware of PrEP but who had not taken it said they did not have enough information to make a decision about using it, and 61 percent said they did not know where to get it. Latinos were more likely than whites to report lacking this knowledge.
When the 544 people who had never taken PrEP were told various key facts about it, 55.9 percent said they were extremely or very likely to go on Truvada. A total of 63.4 percent of Latinos reported these levels of interest, compared with 49.3 percent of whites. A total of 51.4 percent of blacks reported such enthusiasm, although this figure was not statistically different from that of whites or Latinos.
Black respondents were significantly less likely than whites or Latinos to agree that going on PrEP would be a good way to protect them against HIV.
A respective 30.1 percent and 31.5 percent of the respondents agreed that they would not be able to take PrEP because they were uninsured and that they did not know how to obtain health insurance; black and Latinos were more likely than whites to agree on both counts.
A total of 58.9 percent of the respondents said they would not be able to afford PrEP, with Latinos significantly more likely than blacks to say so.
Despite the fact that taking Truvada daily reduces the risk of HIV by more than 99 percent, 58.4 percent of the respondents said they were concerned that PrEP is only partially effective. The survey was taken before news broke of the first documented case of a man contracting a highly drug resistant strain of HIV while apparently adhering well to the PrEP regimen.
A total of 63.4 percent of the respondents were concerned about side effects or feeling sick from taking Truvada.
A total of 70.5 percent of the men disagreed that they would use condoms less frequenrly if they took PrEP. However, 64.4 percent of the respondents said they thought people on PrEP take more sexual risks.
The report made a series of recommendations including to: develop educational campaigns to increase PrEP use among young MSM, especially among black and Latino, low-income MSM and MSM who do not identify as gay; provide places to access PrEP throughout California, especially in communities of color; widely publicize directories of providers who would prescribe PrEP; provide services to help young MSM of color navigate the health care system to obtain PrEP, including helping them obtain health coverage; provide education on PrEP; and use state funds to help pay for PrEP, including the lab tests and office visits required to maintain a prescription.
To read a press release on the report, click here.
To read a policy brief on the report, click here.
To read the report, click here.