Willingness to use Pre-Exposure Prophylaxis among Black and White Men who have Sex with Men in Atlanta, Georgia

Background: A better understanding of factors influencing PrEP uptake among men who have sex with men (MSM) is needed to target prevention interventions and reduce HIV incidence. We hypothesized that factors related to PrEP willingness among white and black MSM in Atlanta, GA may differ given the known disparities in HIV incidence, sociodemographic factors, and healthcare access between these groups.

Methods: We surveyed 482 black and white HIV negative MSM participating in the Emory Involvement study about their willingness to use PrEP, facilitators and barriers to PrEP willingness, and how much they would be willing to pay for PrEP. Differences in factors associated with PrEP willingness between white and black MSM were examined using descriptive statistics and logistic regression analyses.

Results: Overall, 45% (215/482) of men indicated interest in using PrEP. Factors associated with PrEP willingness in univariate analyses included engaging in recent unprotected anal intercourse (UAI) (OR 1.73, 95%CI 1.14, 2.61) and having 3+ sex partners in the past year (OR 2.34, 95%CI 1.40, 3.91). Race, age, education, income, healthcare access, recent homelessness, substance use and HIV testing history were not associated with PrEP willingness. Engaging in UAI remained significantly associated with PrEP willingness in multivariate analyses (OR 1.73, 95%CI 1.13, 2.65). Willing men identified “extra protection” against HIV as the most common reason for interest in using PrEP, whereas unwilling men most commonly cited not wanting to take medication daily, and this reason was more common among white MSM (42.3% of white MSM vs. 28.9% of black MSM, p=0.04). Most men indicated willingness to use PrEP if cost was less than 50 dollars/month; however, more black MSM indicated willingness to use PrEP only if cost were free (17.9% of white MSM vs. 25.9% of black MSM, p=0.03.)

Conclusion: A significant proportion of black and white MSM are willing to use PrEP, and high risk behavior was the only factor significantly associated with PrEP willingness. Implementation of low-cost programs will be important for optimal PrEP uptake, particularly for black MSM. Overall, these data are useful to scale up PrEP interventions targeting at-risk MSM in Atlanta.