Potential Adoption of PrEP Black MSM

Ronald Brooks
University of California, Los Angeles

Social and Behavioral Sciences

Rates of HIV infection among Black men who have sex with men (MSM) nationally and in California continue to increase at alarming rates. Among Black MSM, most new HIV infections occur among young MSM. In order to address this continuing trend, new safe and effective HIV prevention methods are urgently needed.

In the absence of a viable preventive HIV vaccine or microbicide, one novel approach to reduce the risk of HIV infection is the proposed daily use of existing HIV antiretroviral medications by uninfected individuals as Pre-Exposure Prophylaxis (PrEP). This approach is analogous to the once-daily birth control pill to prevent pregnancy. At present, clinical trials are underway to assess the safety and effectiveness of two HIV medications as potential PrEP agents. The adoption and accessibility of PrEP as an HIV prevention strategy will be key determinants of its effectiveness in decreasing the number of new HIV infections among high risk Black MSM.

The goal of this pilot study is to investigate the potential adoption of PrEP among at risk (i.e., HIV negative) Black MSM, a population disproportionately impacted by HIV/AIDS. The study will also examine social and behavioral factors that may facilitate or impede future use of PrEP as an HIV prevention strategy among Black MSM. The study will focus on a hypothetical PrEP medication that has been proven safe and effective, and is ready for dissemination.

The aims of this study are: 1) to examine attitudes and beliefs regarding use of PrEP for HIV prevention among Black MSM, and how attitudes and beliefs vary with sociodemographic characteristics, HIV risk behaviors, perceived risk, perceived severity of HIV, AIDS conspiracy beliefs, HIV stigma, and mistrust of medical and research community; 2) to examine acceptability (i.e., adoption intentions) of PrEP and intentions to change sexual risk behaviors among Black MSM across two hypothetical PrEP scenario medications set at different efficacy levels (i.e., mid level efficacy set at 50% and high level efficacy set at 85%); and 3) to examine the multivariate associations of PrEP acceptability among Black MSM with a broad range of independent variables derived from theory: sociodemographic characteristics, peer social influence, perceived risk, severity of HIV, AIDS conspiracy beliefs, HIV stigma, mistrust of medical and research community, characteristics of PrEP, past health care, and HIV risk behaviors, and to examine similar multivariate associations with separate models for sexual risk behavior intentions.

For this pilot study, data will be collected from a cross-sectional sample of 200 at risk Black MSM in Los Angeles using an audio computer-assisted self-interview (ACASI) system. Half of the study population will consist of young Black MSM ages 18-29, a group that has been disproportionately impacted by HIV infection.

PrEP is a promising new HIV prevention strategy that could be available for use in community settings in the near future. The findings from this study will help inform the dissemination of this new prevention strategy, if it is found to be effective, to at risk Black MSM in California. More importantly, the findings from this pilot study will provide preliminary data to help shape the development of a larger study of PrEP adoption intentions among other at risk racial/ethnic populations and high risk groups (methamphetamine users, transgender individuals, injection drug users, etc.).