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Over 80% of MSM Don't Discuss PrEP With Their
Clinician--and Many Don't Talk About Sex
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IAS 2015, July 19-22, 2015, Vancouver
Mark Mascolini
More than 80% of sexually active US men who have sex with men (MSM) with a primary care provider have not talked to that provider about preexposure prophylaxis (PrEP), and three quarters don't think their provider would prescribe PrEP [1]. Many surveyed men felt uncomfortable even talking about gay sex with their clinician.
Three years have passed since the FDA approved PrEP with tenofovir/emtricitabine, but barriers to wider use persist. Since sexually active gay and bisexual MSM represent a deep pool of potential PrEP users, researchers from Boston's Beth Israel Deaconess Medical Center and collaborators surveyed US users of a gay pickup Web site about their sex behavior and willingness to talk to their provider about sex and PrEP. The investigators limited the analysis to men who had a primary care provider and expressed interest in using PrEP. They used logistic regression to identify factors linked to comfort discussing gay sex with providers and whether they discussed condomless anal sex with providers.
The 1394 survey respondents averaged 44 years in age, and 87% were white, a limitation given the high rates of HIV among black MSM in the United States [2]. Two thirds of respondents (69%) had a college degree, and 47% earned more than $60,000 yearly. Almost half (48%) had condom-free anal sex with 3 or more partners in the past 3 months, and 29% had condom-free anal sex with an HIV-positive partner. One third had a prior sexually transmitted infection, one quarter had a history of depression, half knew about postexposure prophylaxis (PEP), and 5% had used PEP.
While 805 men (58%) reported being comfortable discussing male-to-male sex with their primary provider, 589 (42%) were not comfortable. Similar high proportions in the comfortable and uncomfortable groups (82% and 86%) had not talked about PrEP with their provider, and three quarters in each group (75% and 77%) felt their provider would not be willing to prescribe PrEP. Much higher proportions of men uncomfortable discussing gay sex with their clinician had not discussed condom-free anal sex (89% versus 41% of comfortable men) and would prefer to get PrEP from a source other than their provider (81% versus 33%).
Logistic regression identified four factors independently associated with higher odds of comfort discussing gay sex with a primary care provider, at the following adjusted odds ratios (aOR):
-- Income above $60,000 yearly: aOR 1.89, P = 0.004
-- Prior sexually transmitted infection: aOR 1.60, P < 0.001
-- Depression history: aOR 1.54, P = 0.01
-- Aware of PEP: aOR 1.41, P= 0.07
The same analysis linked six factors to lower odds of comfort discussing gay sex with a primary provider:
-- Heterosexual (versus gay): aOR 0.30, P = 0.01
-- Had not discussed PrEP with provider: aOR 0.72, P = 0.09
-- Prefer PrEP provider other than primary provider: aOR 0.06, P < 0.001
-- Prefer Internet rather than primary provider as PrEP source: aOR 0.14, P < 0.001
-- Prefer another PrEP source rather than primary provider: aOR 0.25, P < 0.001
-- Had a primary provider other than a physician: aOR 0.30, P = 0.01
Another logistic regression model identified two factors independently linked to higher chances of having discussed condomless anal sex with a primary provider and four factors independently linked to lower chances:
-- Latino: aOR 2.21, P = 0.006
-- Aware of PEP: aOR 1.79, P < 0.001
-- Had not discussed PrEP with provider: aOR 0.69, P = 0.02
-- Prefer PrEP provider other than primary provider: 0.14, P < 0.001
-- Prefer Internet rather than primary provider as PrEP source: aOR 0.33, P < 0.001
-- Prefer another PrEP source rather than primary provider: aOR 0.46, P = 0.007
The researchers concluded that "suboptimal communication" with a primary provider "may prevent MSM who are engaged in care from accessing PrEP from primary care providers." They called for innovations "to optimize patient-provider communication about sexual risk behaviors and PrEP."
References
1. Krakower DS, Oldenburg CE, Mimiaga MJ, et al. Patient-provider communication about sexual behaviors and pre-exposure prophylaxis: results from a national online survey of men who have sex with men in the United States. IAS 2015. 8th Conference on HIV Pathogenesis, Treatment and Prevention. July 19-22, 2015. Vancouver. Abstract TUPEC506.
2. Centers for Disease Control and Prevention. HIV among African American gay and bisexual men. http://www.cdc.gov/hiv/group/msm/bmsm.html
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Reported by Jules Levin
Patient-provider communication about sexual behaviors and pre-exposure prophylaxis: Results from a national online survey of men who have sex with men in the US
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