Characterization of healthcare seeking behaviors and perceptions of pre-exposure prophylaxis (PrEP) among HIV-negative men who have sex with men (MSM) in Atlanta, Georgia Open Access

Trost, Susanna (Spring 2019)

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Background: Given high rates of HIV infection in the United States and more specifically in Atlanta, Georgia, there is a need to improve HIV prevention programs by more effectively leveraging the health care system to bolster promotion of pre-exposure prophylaxis (PrEP) to individuals at greatest risk of acquiring HIV. Using data collected from a cross-sectional survey administered by the Fulton County Board of Health (FCBOH) at the 2018 Atlanta Black Pride Festival and the 2018 Atlanta Pride Festival, we examined factors associated with interfacing with the health care system, having discussed PrEP with a provider, and barriers to PrEP uptake among HIV-negative men who have sex with men (MSM) residing in the Atlanta 29-county Metropolitan Statistical Area (MSA). Methods: Chi-square and Fisher’s exact tests assessed differences in health-seeking behaviors and provider discussion of PrEP across key demographic factors. We estimated prevalence ratios for the associations between medical locations visited, HIV risk status, and provider discussion of PrEP using multivariate log binomial models. Associations between demographic factors, healthcare-seeking behaviors, reasons for not taking PrEP, and reasons for being more likely to take PrEP were assessed using bivariate log binomial models. Results: In total, 256 HIV-negative MSM residing in Atlanta MSA were available for analysis. While 87.1% cited interfacing with the healthcare system in the past year, less than one third (31.1%) of PrEP naïve HIV negative MSM reported a provider discussing PrEP. The most frequently cited reasons for not taking PrEP were not knowing enough about PrEP and low risk perception for HIV, with black MSM being more likely than non-Black MSM to cite lack of knowledge about PrEP as a barrier (PR = 1.66, 95% confidence interval [CI]: 1.07, 2.58) and less likely to cite low risk perception for HIV as a barrier (PR = 0.49, 95% CI: 0.34, 0.70). Conclusion: Despite the vast majority of HIV-negative MSM in this sample interfacing with the healthcare system, greater effort on the part of health care providers needs to be made to ensure they routinely inform at-risk individuals about PrEP and appropriately address each patient’s most pressing concerns.

Table of Contents

Table of Contents

Introduction      1

Methods            3

Data Collection 3

Outcomes and correlates of interest       4

Statistical analysis           5

Results 5

Health-seeking behaviors            6

Discussion of PrEP           6

Barriers and perceptions of PrEP              7

Discussion          8

Tables  14

References        17

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