Awareness and Use of Pre-Exposure Prophylaxis among Men who have Sex with Men in Dallas, Texas, 2017: Prevalence, Associated Factors and Predictors.

Background: Gay, bisexual, and other men who have sex with men (MSM) are at high risk of acquiring human immunodeficiency virus (HIV). Taking pre-exposure prophylaxis (PrEP) daily reduces the risk of acquiring HIV through sexual contact by up to 99%. This study aimed to assess the prevalence of PrEP awareness and use, and the associated factors among HIV-negative, sexually active MSM in Dallas, Texas. Methods: Data from 406 HIV-negative, sexually active MSM recruited through venue-based sampling in 2017 and obtained from the National HIV Behavioral Surveillance project in Dallas, Texas, were analyzed. We used descriptive and inferential statistics that included bivariate and multivariate regression models to explore the associations between self-reported PrEP awareness and use, and the sociodemographic characteristics and high-risk sexual behaviors. Results: Prevalence of PrEP awareness and use in the past 12 months were 83.7% and 18.2%, respectively. PrEP awareness was significantly (p<0.05) less common among Black and Hispanic/Latino MSM (80.0% and 77.2% respectively) and among those with a high school diploma/General Educational Development (GED) or less (65.3%) or five or less male sexual partners in the past 12 months (80.4%). It was also lower among those with a household income of less than $20,000 (55.4%) and persons experiencing homelessness (57.7%) or incarceration (61.3%). PrEP use was significantly (p<0.05) lower among Black and Hispanic/Latino MSM (11.7% and 13.8% respectively) as well as those without health insurance (12.3%), with a high school diploma/GED or less (9.2%), and with household income lower than $20,000 (7.1%). PrEP awareness was 13% less common among Black MSM (adjusted prevalence ratio [aPR]=0.87, 95% confidence interval [CI]: 0.79-0.97) and 15% less common among Hispanic MSM (aPR=0.85, 95% CI: 0.78-0.93) compared to White MSM. In contrast, PrEP awareness (aPR: 1.12, 95% CI: 1.02-1.22) and use (aPR:2.02, 95% CI: 1.42-2.88) were significantly (p<0.05) associated with participation in HIV behavioral interventions. Conclusion: The positive association of HIV behavioral interventions with both PrEP awareness and use suggests that this approach may enhance PrEP rollout in Dallas and also serve as a model for statewide campaigns in the MSM communities. In addition, efforts to increase PrEP awareness and use should target Black and Hispanic MSM and MSM with lower socioeconomic status (SES). [ABSTRACT FROM AUTHOR]