Intersecting Communities and PrEP Uptake Among Latinx Sexual Minority Men

Background and Purpose: The Latinx community in the U.S. continues to be disproportionately burdened by the HIV epidemic, especially among Latinx sexual minority men (LSMM). Research indicated that up to two-thirds of new HIV infections among men who have sex with men may occur within primary partnership. One promising biomedical approach for HIV prevention is community scale-up of pre-exposure prophylaxis (PrEP) among LSMM. We examined the relationship between community connectedness (with the Latinx and gay communities) and Pre-exposure Prophylaxis (PrEP) uptake among 307 partnered Latinx adult sexual minority men (LSMM) who reported casual partner sex.

Methods: Online surveys were administered in Spanish and English from a nationwide sample of LSMM in the U.S. Participants were recruited via location-based social media applications. PrEP uptake was measured using a single-item self-report measure. We assessed gay community connectedness (GCC) using the Gay Community Attachment Scale with items such as “I am happy that I am a member of the gay/bisexual community” and “I have a strong sense of belonging to the gay/bisexual community.” We additionally assessed Latinx group membership (LGM) using the Group Membership Questionnaire with items such as, “The ethnic group that I belong to is unimportant to my sense of what kind of person I am.” We also assessed participants’ demographic characteristics. Analyses followed two steps: First, bivariate analyses examined relationships between demographic characteristics, GCC, LGM, and PrEP uptake. Second, a multivariable logistic regression model was used to estimate the interaction between LGM and GCC, and its effect on PrEP uptake.

Results: Nearly half of the sample was 31years or older (49.5%) and about half (46.6%) of the participants had been in an ongoing relationship for more than 3 years by the time the study was conducted. Over half (54.4%) of the participants were born in the U.S., and 41.0% had an annual income higher than $30,000. Almost three-fifths (59.3%) of the participants had health insurance. Notably, over eighty percent (80.8%) of the LSMM indicated English language preference. In total, 91 (29.6%) were currently prescribed PrEP. Nearly forty-four percent (43.3%) partner approval for being on PrEP, and 7.2% were opposed to PrEP. In bivariable analyses, insurance status and income level were significantly associated with PrEP uptake (p <0.001 for both). Holding constant average levels of gay community connectedness, increases of Latinx community connectedness was associated with PrEP uptake (OR = 2.12; p = .002). The interaction term (LGM*GCC) was significant suggesting the intrinsic relationship between gay and Latinx community connectedness in the prediction of PrEP uptake (OR = 2.18; p = .007).

Conclusions and Implications: Our study suggested that only about 30% of the LSMM in our sample were currently using PrEP, which supports prior research demonstrating that current HIV prevention effects did not adequately reach LSMM. There might be structural barriers preventing this population from seeking and initiating PrEP care. Findings point to the utility of integrating attention to intersecting identities when conceptualizing community-based and culturally informed interventions to improve the PrEP care cascade among partnered LSMM.