case study

California Young MSM PrEP Study

We investigated PrEP disparities among young gay and bisexual men across California

Client: APLA Health and Wellness

The Issue

We conducted a state-wide survey to investigate PrEP awareness, attitudes, uptake, and barriers among 602 young men who have sex with men (YMSM) in California.

 

The Outcomes

Our study led to practical solutions that HIV service organizations used to better promote PrEP to YMSM.

Publications

Addressing PrEP Disparities among Young Gay and Bisexual Men in California
Pulsipher C, Montoya JA, Plant A, Holloway, IW, Leibowitz A. California HIV/AIDS Research Program (CHRP). September 2016.

Facilitators and Barriers to Pre-Exposure Prophylaxis Willingness Among Young Men Who Have Sex with Men Who Use Geosocial Networking Applications in California.
Holloway IW, Tan D, Gildner JL, Beougher SC, Pulsipher C, Montoya JA, Plant A, Leibowitz A. AIDS Patient Care and STDS. 2017; (12):517-527.

PrEP Uptake, Adherence, and Discontinuation among California YMSM Using Geosocial Networking Applications.
Holloway I, Dougherty R, Gildner J, Beougher SC, Pulsipher C, Montoya JA, Plant A, Leibowitz A. Journal of Acquired Immune Deficiency Syndromes. 2016; 74(1): 15–20.

Presentations

PrEP Awareness, Attitudes and Uptake Among Racially/Ethnically Diverse Young Men Who Have Sex with Men in California.
Pulsipher C, Holloway IW, Gildner J, Beougher S, Curtis P, Plant A, Montoya J, Leibowitz A. Presented at: AIDS 2016 – International AIDS Conference; July 18-22, 2016; Durban, South Africa.

PrEP — A Highly Effective Biomedical HIV Prevention Intervention 

The Centers for Disease Control and Prevention (CDC) estimates that if current rates persist, half of all Black— and a quarter of all Latinx—gay and bisexual men could be infected with HIV in their lifetime. PrEP uses a well-established antiretroviral medication combination to block HIV infection in at-risk HIV-negative individuals. When taken as prescribed, PrEP is highly effective at preventing HIV.

In 2015, despite the availability of PrEP, awareness and uptake were low among at-risk populations. Barriers to PrEP use among YMSM needed to be better understood and addressed so the benefits of this HIV prevention strategy could be fully realized. We partnered on the study with APLA Health and Wellness, and the California HIV/AIDS Policy Research Center at UCLA. The study was funded by a grant from the University of California HIV/AIDS Research Program, with additional support from the UCLA Center for HIV, Identification, Prevention and Treatment Services (CHIPTS). 

Sentient Research conducted an online survey to examine levels of PrEP awareness, current use, likelihood of future use, and attitudes and barriers to PrEP uptake among YMSM. Individuals were eligible if they were HIV negative, a California resident, 18–29 years of age, and MSM. YMSM were recruited through ads on several geosocial networking apps and websites. Given the disproportionate impact of HIV among Black and Latinx YMSM, this study focused specifically on outcomes for these groups in comparison to their White counterparts.  

The study uncovered important barriers to PrEP uptake including concerns about cost, lack of health insurance, not knowing where to access PrEP, concerns about side effects, and stigma.  

A total of 602 YMSM participated in the survey. Nearly 10% of respondents reported having used PrEP. Awareness of PrEP was significantly higher among White respondents (87%) compared to Black (63%) and Latinx (72%) respondents. PrEP awareness was significantly lower among younger men, and higher among gay-identified respondents (78%) compared to bisexual respondents (52%). Among those who had never used PrEP, the majority indicated they did not have enough information to make a decision about using it (71%) and did not know where to get PrEP (61%), with Latinx respondents being significantly more likely to indicate lack of knowledge in comparison to White respondents. 

Most respondents had favorable attitudes toward PrEP. However, the study uncovered several important barriers. These included concerns about cost, lack of health insurance, not knowing where to access PrEP, concerns about side effects, and stigma surrounding taking PrEP. These barriers were nearly all higher among Black and Latinx MSM. 

Based on the findings of the study, our report, Addressing PrEP Disparities among Young Gay and Bisexual Men in California, made the following set of recommendations: 

  1. Targeted education campaigns and interventions are needed to increase PrEP awareness and uptake, especially among Black and Latinx, low-income, and non-gay-identified YMSM.
  2. Culturally responsive and linguistically appropriate interventions are needed to increase PrEP uptake among YMSM, particularly Latinx YMSM.
  3. PrEP access points must be available throughout the state, particularly in communities of color, and provider directories should be widely publicized.
  4. PrEP navigation services tailored to the needs of YMSM of color are essential, and must include screening for and enrollment in health coverage.
  5. PrEP education must provide clear and consistent information on side effects and efficacy.
  6. California should use public funds to help pay for PrEP, including PrEP-related clinical ancillary services.
  7. California’s laws addressing medical confidentiality must be widely publicized, especially for YMSM on another person’s health plan.
  8. Education campaigns should be developed that challenge stereotypical assumptions about who is an appropriate candidate for PrEP.
  9. PrEP outreach and education efforts should follow the market—online.
  10. Provider education is essential to increasing awareness and uptake of PrEP, including encouraging doctors to talk to patients about their sexual behavior.