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Research on incarcerated men indicates low Pre-Exposure Prophilaxis (PrEP) access and use, even though HIV disproportionately affects this population. Intersecting attributes—urban, formerly incarcerated, Black, heterosexual men with substance use diagnoses (SUDs) —improves the odds of HIV transmission and thus HIV acquisition. It is crucial to determine, among key populations, those individuals who might be eligible to take PrEP to prevent transmission and acquisition. However, PrEP-eligibility research is lacking. Individuals vulnerable to HIV infection are accessing PrEP because they are identified as ineligible. This study uses stringent criteria to demonstrate how to assess PrEP eligibility among Black Heterosexual Men.
Methods
This exploratory quantitative study used the five criteria recommended by the United States Centers for Diseases Control and Prevention (CDC) to determine PrEP eligibility: (1) HIV-negative test and (2) sexually active plus (3) a sexual partner living with HIV, (4) and/or diagnosed with an STI, (5) and/or inconsistent or no condom use for intercourse. Using survey questions, we measured if participants had been tested for HIV, their perception of vulnerability, and whether or not they had access to PrEP information. To assess differences between PrEP-eligible and non-eligible participants, we used Chi-square tests for categorical data and independent t-tests for continuous variables. This is indeed an exploratory study that uses the appropriate research method to answer a question with epidemiological implications.
Results
We identified a considerable percentage (n=61; 32.8%) of PrEP-eligible individuals in a sample (n=186) of urban, formerly incarcerated, Black, heterosexual men diagnosed with SUDs. PrEP-eligible men reported more instances of sexual activity than PrEP-ineligible ones, X2(1, N=186) = 85.09, p< .001. PrEP eligible men reported significant more condomless sex, X2(1, N=185) = 90.58, p< .001. Most eligible (78.7%) and ineligible (86.3%) participants had not received PrEP information from service providers. Most eligible (85.2%) and ineligible (79.4%) men reported that they were “not likely” to contract HIV (unaware of vulnerability). We found no significant differences between groups of eligible and ineligible men in terms of their demographic characteristics.
Conclusion
Accurate determination of PrEP-eligibility allowed us to advance research on the incongruence of an individual’s PrEP-eligibility status and unawareness of vulnerability to HIV acquisition and lack of PrEP information. This has important implications because accessing PrEP information is the first step to accessing PrEP. The relevance of future interventions to improve PrEP access hinges on the accurate determination of PrEP-eligibility. Research is recommended on innovative ways to enhance PrEP-eligible individuals’ awareness of their vulnerability to HIV acquisition, and to improve dissemination of PrEP-information as a prevention strategy.