Assessing Geographic and Urban Disparities in Pre-exposure Prophylaxis (PrEP) Access and Care Among a Cohort of Men Who Have Sex with Men Open Access

Rossiter, Shannon (Spring 2020)

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Men who have sex with men (MSM) have been recognized by the Centers for Disease Control and Prevention (CDC) as a high-risk group for HIV, making up approximately 67% of new infections in 2017. Pre-exposure prophylaxis (PrEP) has been established as a particularly highly effective preventative treatment against HIV in MSM. Despite this, there is low uptake of PrEP among MSM. There are known geographic differences that exist between new HIV diagnoses and PrEP uptake: the South experiences the greatest HIV burden, and urban areas have better access to HIV care and resources, including access to PrEP. However, prior studies have not assessed geographic disparities in HIV care and PrEP use on a national scale. To assess whether there were geographic and urban disparities among MSM, we used data from a cohort of 10,127 participants from the American Men’s Internet Survey (AMIS) from 2018 and employed conditional margin regression and spatial analyses. Most participants resided in the South (38.2%) and participants living in urban counties were 2.4 times more likely than their rural counterparts to have ever used PrEP (PR = 2.40, 95% CI = [1.06, 5.43]). Additionally, more participants in the West had ever used PrEP (27.8% - 42.6%), while more MSM in the South and Midwest were willing to use PREP (53.9%-60.1%). Based on these results, there is a disconnect between who wants access to PrEP care and who is able to access it, suggesting the need for large-scale regional interventions in the areas showing lower prevalence of MSM and these PrEP outcomes.

Table of Contents

Introduction 4

Methods 7

Results 10

Discussion 12

Conclusions 14

Figures and Tables 15

References 20

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