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Reported preexposure prophylaxis use among male sex partners of HIV-positive men
2016-2018
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Condomless anal intercourse was associated with PrEP use. Although increased condomless sex could be a barrier to PrEP uptake [20] and PrEP may increase ‘risk compensation’ [26,27], our findings suggest that PrEP use was higher in partnerships where there was risk of HIV transmission, that is, when partners engaged in condomless anal intercourse without sustained viral suppression. While sex without condoms may be a facilitator of PrEP use [19], this should be balanced with assessment of STD risk, which has been increasing among MSM [28].
PrEP use was reported among one in five partners, with disparities between black and white partners. Assessing the use of multiple prevention strategies among a population-based sample in a real-world setting allows for a more comprehensive assessment of risk. Increasing PrEP use and decreasing racial/ethnic disparities could reduce disparities in HIV incidence and help end the US HIV epidemic [24,25,29].
Abstract
Objective:
To estimate the proportion of US HIV-positive men who report a male HIV-negative/unknown status (HIV-discordant) sexual partner taking preexposure prophylaxis (PrEP), and the use of multiple HIV prevention strategies within partnerships.
Design:
The Medical Monitoring Project is a complex sample survey of US adults with diagnosed HIV.
Methods:
We used data collected during June 2016 to May 2018 among sexually active HIV-positive men who had at least one HIV-discordant male partner (N = 1871) to estimate the weighted prevalence of reporting at least one partner taking PrEP. Among HIV-discordant partnerships (N = 4029), we estimated PrEP use, viral suppression among HIV-positive partners, and condomless anal sex. We evaluated significant (P < 0.05) differences between groups using prevalence ratios with predicted marginal means.
Results:
Twenty-eight percent of sexually active HIV-positive MSM reported at least one HIV-discordant male partner taking PrEP.
Twenty percent of HIV-discordant partners were reported to be taking PrEP; 73% were taking PrEP or the HIV-positive partner was virally suppressed.
PrEP use was lower among black and Hispanic partners compared with white partners (12% and 19% vs. 27%).
Fewer black than white MSM were in partnerships in which PrEP was used or the HIV-positive partner had sustained viral suppression (69% vs. 77%). Condomless anal intercourse was more prevalent in partnerships involving PrEP use and in partnerships involving either PrEP use or sustained viral suppression among the HIV-positive partner.
Conclusion:
PrEP use was reported among one in five partners, with disparities between black and white partners. Increasing PrEP use and decreasing racial/ethnic disparities could reduce disparities in HIV incidence and help end the US HIV epidemic.
Results
Among HIV-positive MSM with HIV-discordant male partners, 28% reported having at least one male partner taking PrEP (Table 1).
Non-Hispanic black MSM were less likely than Hispanic/Latino or non-Hispanic white MSM to report having a partner taking PrEP (22% vs. 31% and 31%).
Reporting a partner taking PrEP was associated with the HIV-positive person being younger, not being in poverty, and having private insurance.
Reporting a partner taking PrEP was associated with having more partners but not significantly associated with the HIV-positive person having sustained viral suppression or being retained in HIV care. Factors independently associated with partner PrEP use were age, race/ethnicity, poverty, private health insurance, length of time since HIV diagnosis, and having more than one partner.
Among all HIV-discordant male partnerships (Table 2), 20% of partners were reported to be taking PrEP. Overall, 73% were either taking PrEP or were the partner of an HIV-positive person who had sustained viral suppression. Reported PrEP use was significantly higher among younger partners and in partnerships with a higher level of commitment. Reported PrEP use was lower among black and Hispanic partners compared with white partners (12% and 19% vs. 27%, prevalence ratio = 0.44 and prevalence ratio = 0.69, respectively). Reported PrEP use was not associated with the viral status of the HIV-positive person. Factors independently associated with partner PrEP use were age, race/ethnicity, and level of commitment. A significantly lower proportion of black MSM, compared with white MSM, were reported to be either taking PrEP or the partner of a person who had sustained viral suppression (69% vs. 77%, prevalence ratio = 1.37).
Condomless anal intercourse was more likely in partnerships with reported PrEP use [64% (95% CI 58-69) vs. 40% (95% CI 36-43), prevalence ratio = 1.61 (95% CI 1.45-1.79, P < 0.001)] and also more common in partnerships in which either PrEP was used by the HIV-discordant partner or the HIV-positive partner had sustained viral suppression [47% (95% CI 43-52) vs. 36% (95% CI 30-43), prevalence ratio = 1.30 (95% CI 1.07-1.59, P = 0.005), results not reported in tables]. Condomless anal intercourse with the HIV-negative person as the receptive partner was over twice as likely in partnerships with reported PrEP use [36% (95% CI 31-42) vs. 16% (95% CI 14-18), prevalence ratio = 2.29 (95% CI 1.91-2.75, P < 0.001)] and also more common in partnerships in which either PrEP was used by the HIV-discordant partner or the HIV-positive partner had sustained viral suppression [23% (95% CI 19-26) vs. 13% (95% CI 9-17), prevalence ratio = 1.72 (95% CI 1.19-2.49, P = 0.003)].
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