Identifying profiles of sexual risk and PrEP initiation among Black sexual minority men in HPTN 073


BACKGROUND: Black gay, bisexual, and other Black sexual minority men (BSMM) continue to bear the greatest HIV burden in the U.S. Efforts to'¯successfully'¯engage BSMM to use pre-exposure prophylaxis (PrEP) are urgently needed. However, additional strategies'¯to'¯understand HIV risk profiles among BSMM are needed. Since few studies show high uptake of PrEP among BSMM, the purpose of this study is to'¯identify sexual risk profiles and'¯PrEP'¯use among'¯BSMM in the vanguard study HPTN 073.
METHODS: A total of 226 BSMM were recruited from Los Angeles, CA, Chapel Hill, NC, and Washington D.C. from 2013 to 2015; 79% initiated PrEP. Latent class analysis (LCA) was used to identify sexual risk profiles using baseline data from HPTN 073 study (n=226). Relationship status, condom use, number of sexual partners, substance use, STI history, and partner HIV status were used as latent class indicators as guided by the CDC PrEP risk behavior assessment. Age and PrEP initiation were used as covariates in a multinomial regression to identify correlates of class membership.
RESULTS: Three latent classes were identified:
1) Single with Condomless Partners (69.4%),
2) Single with Multiple Partners (19.0%), and
3) Serodiscordant Partners (11.5%).
Single with Multiple Partners had the highest conditional probability of having condomless sex (90.5%), having greater than three male partners in the previous six months (93.6%), substance use before sex (58.1%), and receiving an STI diagnosis in the previous six months. Serodiscordant Partners had a 100% conditional probability of both engaging in condomless sex with a male partner and having a male partner who was living with HIV. Relative to BSMM who did not initiate PrEP, BSMM who initiated PrEP had 93% lower odds of being classified as Single with Condomless Partners than Serodiscordant Partners, after adjusting for age (AOR=0.07, 95% CI=0.02, 0.66).
CONCLUSIONS: Findings show low odds for PrEP use among single men with condomless partners, an important subgroup of BSMM with high-transmission risk behaviors who comprise most of this sample. Conversely, serodiscordant partners were more likely to use PrEP. To increase uptake of PrEP, culturally relevant tailored and targeted messaging strategies for BSMM with a combination of high sexual risk indicators are needed.