20th International AIDS Conference - Melbourne, Australia

Abstract

MOPE293 Poster Exhibition


How Black men who have sex with men in New York City understand, talk about, and experience pre-exposure prophylaxis (PrEP)

Presented by Morgan M Philbin (United States).

M.M. Philbin1, R. Parker2, P. Wilson2, K. Grisham2, C. Parker2, J. Garcia2, J. Hirsch2


1Columbia University, New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, United States, 2Columbia University, Sociomedical Sciences, New York, United States

Background: Black men who have sex with men (BMSM) have the highest HIV incidence rates in the United States, particularly in urban centers like New York City. Research has demonstrated the effectiveness of pre-exposure prophylaxis (PrEP), but little is known about how BMSM understand, talk about, and experience PrEP.
Methods: BMSM in New York City (n=26), selected to represent a range of incomes, sexual identities, ages, and insurance coverage each completed three in-depth interviews, for a total of 270 minutes of interview data. Thirteen key informants (e.g. community leaders and health care and social service providers) also participated. After receiving consent, we taped, transcribed, and analyzed interviews to explore how individuals talked about their understanding of, and potential barriers to, using PrEP.
Results: The majority of participants had never heard of PrEP. After learning about PrEP, individuals reported a number of factors that would influence likelihood of use. First, men disliked taking medication and felt a daily pill was “too much commitment” just for sex. Some participants reported not taking medication for existing conditions (e.g. diabetes, heart disease), and said they wouldn''t want to take medication, particularly one with side effects, when they were not sick. Second, men reported that taking a medication associated with HIV might generate stigma, particularly since they felt friends and family already associated their sexuality with HIV risk. Third, some men believed that unprotected sex would increase if people took PrEP, while others felt condoms would still be necessary since PrEP doesn''t protect against other STIs. Such conclusions led participants to question the usefulness of PrEP. Lastly, most participants thought PrEP was a potentially successful as a strategy for others, but not for themselves.
Conclusions: BMSM are listed as a key population in the U.S. National HIV/AIDS Strategy, yet few of the individuals we spoke with had heard of PrEP and fewer still believed PrEP would be personally helpful. This research indicates the urgent need to (1) raise awareness, (2) guarantee access, and (3) expand enabling environments that facilitate the scale-up and implementation of PrEP-related services in New York City and elsewhere in the United States.

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