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Exploration of the Complex Relationships Among Multilevel Predictors of PrEP Use Among Men Who Have Sex with Men in the United States

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Abstract

To explore the relationships among individual-, social-, and contextual- (state-level characteristics, including LBGTQ + and racial inequality) level factors and PrEP use. A cross-sectional survey was conducted in 2015–2016 among a geographically diverse group of men who have sex with men (MSM). Survey data was linked to publicly available state-level data based on participant zip code. Multivariable multilevel logistic regression was used to explore the association between multilevel variables and PrEP use. Of 4165 HIV-negative MSM, 13.4% were taking PrEP. In the regression analysis, several demographic and behavioral factors were associated with higher odds of PrEP use. Importantly, after adjusting for individual- and social-level factors, residents of states with high LGBTQ + equality had significantly higher odds of taking PrEP (OR 1.57; 95% CI 1.119, 2.023) compared to low equality states. LGBTQ + inequality between states may hinder PrEP use. States may need to take proactive measures to reduce LGBTQ + inequality as this may negatively impact the ability to reach the federal administration’s stated goal to end the HIV epidemic in the US.

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Acknowledgements

Support for this manuscript was provided by the Centers for Disease Control and Prevention-funded NYU-CUNY Prevention Research Center (U48DP005008) Special Interest Project (SIP 15-009: Christian Grov/Simona Kwon—MPI). Thank you to Virginia “Ginny” Bowen and Kyle Bernstein at the CDC and the many participants who gave their time. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA

    Kristina Rodriguez, Elizabeth A. Kelvin, Denis Nash & Katarzyna Wyka

  2. CUNY Institute for Implementation Science in Population Health, New York, NY, USA

    Elizabeth A. Kelvin, Christian Grov & Denis Nash

  3. Aaron Diamond AIDS Research Center/Columbia University, New York, NY, USA

    Kathrine Meyers

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  1. Kristina Rodriguez
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  2. Elizabeth A. Kelvin
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  3. Christian Grov
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  4. Kathrine Meyers
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  6. Katarzyna Wyka
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Correspondence to Christian Grov.

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Rodriguez, K., Kelvin, E.A., Grov, C. et al. Exploration of the Complex Relationships Among Multilevel Predictors of PrEP Use Among Men Who Have Sex with Men in the United States. AIDS Behav 25, 798–808 (2021). https://doi.org/10.1007/s10461-020-03039-1

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