Provider-Patient Communication and HIV Prevention Outcomes Among MSM in the US: An Analysis of AMIS 2024 Restricted; Files Only

Abstract

Men who have sex with men (MSM) continue to experience disproportionate HIV burden in the United States, and persistent gaps in HIV testing and PrEP use highlights the need to understand factors that shape prevention engagement. This study examined how communication between patients and providers influences HIV testing and current PrEP use using data from the 2024 American Men’s Internet Survey, a national, web‑based survey of MSM. The analysis focused on two communication exposures: disclosure of same sex behavior to a healthcare provider and provider initiated sexual health discussions. Descriptive statistics, bivariate analyses, and modified Poisson regression were used to estimate crude and adjusted associations, and an exploratory joint exposure variable was created to assess combined communication experiences. The analytic sample included 2,156 respondents who were HIV-negative or of unknown status for the HIV testing analyses, and 2,863 respondents for the PrEP analyses. Both disclosure and provider-initiated discussions were independently associated with higher frequency of HIV testing, and provider-initiated discussions were independently associated with current PrEP use. Disclosure alone was not significantly associated with PrEP use after adjustment. Joint exposure analyses revealed a clear gradient in prevention engagement, with the highest levels of HIV testing and PrEP use among respondents who both disclosed and received a sexual health discussion. These findings highlight communication as a central component of the HIV prevention cascade and underscore the importance of provider behavior in facilitating prevention uptake. Strengthening provider initiated sexual health conversations and reducing barriers to disclosure may help improve HIV testing and PrEP use among diverse communities of MSM. Interventions that support affirming, routine, and patient centered communication may contribute to more equitable HIV prevention outcomes across the United States.

Table of Contents

Table of Contents: Introduction...................................................................................................................1 Methods........................................................................................................................4

Study Design and Data Source ......................................................................................4

Study Population.........................................................................................................4

Dependent Measures....................................................................................................5

Covariates..................................................................................................................6

Statical Analysis .........................................................................................................7

Results..........................................................................................................................9

Table 1B. Sample Characteristics of MSM In AMIS 2024, Overall and By PrEP Use Status (Past 12 Months)..................................................................................................................11 Table 2. Associations Between Communication Variables and HIV Testing.......................13

Table 3. Associations Between Communication Variables and PrEP Use .......................14

Table 4: Cross-Tab of 2 Exposures and Overlap................................................................15

Table 5: Joint Exposure of Disclosure and Provider-Initiated Sexual Health Discussion in Relation to HIV Testing (Past 12 Months)........................................................................16 Table 6: Joint Exposure of Disclosure and Provider-Initiated Sexual Health Discussion in Relation to Current PrEP Use .........................................................................................17 Discussion...................................................................................................................17

Conclusion ..................................................................................................................21

References...................................................................................................................22

Appendix ....................................................................................................................28

Survey Items ............................................................................................................28

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	HIV Prevention PrEP Provider-Patient Communication Sexual Health Communication
Committee Chair / Thesis Advisor	Dr. Travis Sanchez , Emory University

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