Racial Disparities Prevalent in HIV PrEP Discussion and Use

Among gay, bisexual, and other men who have sex with men (MSM), fewer black and Hispanic men discussed HIV pre-exposure prophylaxis (PrEP) use with a health care provider or had used PrEP in the last year when compared to white men of the same population, according to a new Morbidity and Mortality Weekly Report.

Investigators from the US Centers for Disease Control and Prevention (CDC) reviewed the 2017 National HIV Behavioral Surveillance data in order to understand racial and ethnic disparities in PrEP awareness, discussions with health care providers, and use. There were 10,104 sexually-active MSM in 23 urban areas interviewed; 40% tested negative for HIV and likely met clinical indications for PrEP use. In 2017, initial data showed that MSM accounted for two-thirds of new HIV diagnoses, with black and Hispanic MSM being disproportionately affected. Additionally, MSM who inject drugs accounted for 3% of new HIV diagnoses the study authors found after the initial review.

After further analysis, the investigators learned that black and Hispanic MSM were significantly less likely than their white counterparts to be aware of PrEP, to have discussed PrEP with a health care provider, or to have used PrEP within the past year.

PrEP reduces the risk for sexual HIV transmission by about 99% when taken daily as prescribed, the investigators added in their paper. For those MSM who had discussed PrEP with a health care provider within the previous year, 68% of white MSM, 62% of Hispanic MSM, and 55% of black MSM reported they used PrEP. White MSM who had discussed PrEP with their health care provider were significantly more likely to use PrEP than black counterparts, the investigators learned. This held true even when white and black MSM had health insurance and a usual source of health care — “typical barriers to accessing prescription medication,” the study authors wrote.

Dafna Kanny, PhD, epidemiologist, CDC’s Division of HIV/AIDS Prevention, and author of the report told Contagion® that while the results were not particularly surprising, the findings “underscore the need for interventions that increase PrEP awareness and discussion to include both patients and health care providers.”

Kanny said that health care providers might make clinical decisions based upon inaccurate assumptions about racial and ethnic minority patients. When combined with black and Hispanic gay and bisexual men not trusting health care providers, discussions and use of PrEP can be inhibited. Another way Kanny suggested to decrease these disparities is to increase the number of health care providers prescribing PrEP in black and Hispanic neighborhoods to enhance the quality of care for PrEP patients.

The study authors said that the nation would take one more step toward their goal of preventing new HIV infections by emphasizing the use of PrEP for all MSM and addressing the racial and ethnic disparities, particularly in discussion with health care providers.

“As part of its Prescribe HIV Prevention campaign, CDC offers a variety of resources, in English and Spanish, to help health care providers assess HIV risk and offer PrEP to patients who might benefit from it,” Kanny said, adding that CDC has full suite of materials including a pamphlet to help guide clinicians through sexual health discussions with patients. “Providers who interact with gay and bisexual men — and especially African American and Latino gay and bisexual men—may benefit from more training and resources about PrEP to prevent HIV. Health care providers could also benefit from culturally tailored training on taking a sexual history, which is essential for identifying African American and Latino gay and bisexual men who could benefit from PrEP.”