The effects of substance use and mood disorders on the use of HIV pre-exposure prophylaxis among young black men who have sex with men Open Access

Serota, David Phillip (Spring 2019)

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Daily HIV pre-exposure prophylaxis (PrEP) is >95% effective in preventing HIV infection among populations at increased risk. Young black men who have sex with men (BMSM) in the southeast are the demographic with the highest HIV incidence in the United States, but have inadequate PrEP uptake and persistence on PrEP. The objective of this research was to investigate whether the high prevalence of substance use and mood disorders among young BMSM leads to inadequate PrEP.


The EleMENt cohort is a prospective observational cohort of HIV-negative young BMSM in the Atlanta. Participants are offered enrollment in an optional PrEP program, that provides clinical services for PrEP, prescriptions, and assistance paying for medication. The association between substance use and the prevalence of mood disorders was evaluated using logistic regression. Kaplan-Meier survival functions were created for time to PrEP initiation and time to PrEP discontinuation. Cox proportional hazards models were created to identify how substance use, mood disorders, and other covariates were associated with PrEP uptake and PrEP discontinuation.


298 HIV-negative young BMSM were followed longitudinally for 24 months. There was a 30% prevalence of moderate to severe mood disorder symptoms at baseline. Sixty eight percent used marijuana, 14% used cocaine, and 30% had risky alcohol use. Forty two percent (125/298) initiated PrEP during the study period. Marijuana was associated with less PrEP uptake and higher education, self-efficacy, and STIs with more uptake. Of the 125 who initiated PrEP, 79 (63%) discontinued PrEP during follow up. Marijuana use was associated with more discontinuation along with younger age and fewer sex partners. Cocaine use, risky alcohol use, and mood disorders had no association with either PrEP uptake or discontinuation and there was no statistical interaction between substance use and mood disorders.


PrEP uptake and persistence in this cohort of young BMSM was suboptimal despite education and access to free PrEP services. Marijuana use was associated with both less PrEP uptake and more discontinuation, while the other substances and mood disorders had no significant effect. Special attention to the youngest and marijuana using BMSM is needed to maximize PrEP effectiveness in this key population.

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