“That’s kind of like the big struggle right now is can we get PrEP?”: Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men

Abstract Introduction The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population’s uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM. Methods Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques. Results Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers’ negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support. Conclusions Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers’ PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain. Policy Implications A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.

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Insurance- and medical provider-related barriers and facilitators to staying on PrEP: results from a qualitative study

Translational Behavioral Medicine ◽

10.1093/tbm/ibz191 ◽

2020 ◽

Cited By ~ 3

Author(s):

Alexa B D’Angelo ◽

Javier Lopez-Rios ◽

Anthony W P Flynn ◽

Ian W Holloway ◽

David W Pantalone ◽

...

Keyword(s):

Qualitative Interviews ◽

Insurance Coverage ◽

Gay And Bisexual Men ◽

Barriers And Facilitators ◽

Health Clinic ◽

Bisexual Men ◽

Medical Provider ◽

Prep Implementation ◽

And Bisexual ◽

Hiv Acquisition

Abstract Pre-exposure prophylaxis (PrEP) is a highly effective biobehavioral strategy for preventing HIV acquisition. Although PrEP uptake has increased steadily, discontinuation rates are high among members of key populations like gay and bisexual men (GBM). Understanding the challenges that arise for PrEP users is key to better PrEP implementation and sustained use over time. We report on barriers that arose for PrEP-using GBM, as well as facilitating factors that aided PrEP persistence, with the goal of informing PrEP implementation efforts. In 2015–2016, 103 PrEP-using GBM in NYC completed qualitative interviews about their engagement with PrEP, including their experiences navigating PrEP-related medical care. Interviews were transcribed verbatim, coded, and analyzed thematically. Over half of participants (53%) received their PrEP-related care from their primary care provider (PCP), one-third (33%) from a community-based health clinic, and 13% from multiple medical providers. Emergent themes regarding the barriers and facilitators to PrEP persistence fell into two categories: insurance- and medical appointment-related barriers and facilitators to continued PrEP use. The experiences of PrEP-using GBM can provide useful insights for providers, program developers, and policymakers aiming to improve the implementation of PrEP. To support PrEP persistence, reliable insurance coverage, cost-assistance, and easy appointment scheduling are key to maintenance. Removing insurance- and appointment-related barriers to persistence may prove essential for sustaining use among GBM.

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Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study

Venereology ◽

10.3390/venereology1010003 ◽

2021 ◽

Vol 1 (1) ◽

pp. 9-22

Author(s):

Lourence Misedah ◽

Michael W. Ross ◽

Solomon Wambua ◽

Vanessa Schick

Keyword(s):

Sexual Health ◽

Qualitative Interviews ◽

Gay And Bisexual Men ◽

Public Healthcare ◽

Bisexual Men ◽

Survival Sex ◽

Healthcare Settings ◽

Self Testing ◽

And Bisexual ◽

Public Clinics

Refugees are often without financial support and some resort to survival sex. Some of these men are gay or bisexual who fled their countries because of actual or fear of death and other persecution, exacerbated by the criminalization of consensual same-sex practices by life imprisonment or death in extreme cases. We conducted qualitative interviews with 12 gay and bisexual men within a larger sample in Nairobi, Kenya, who engaged in survival sex. Thematic analysis indicated eight main themes: Physical dangers, sexual assault, lack of rights and recourse to justice; Emotional difficulties of sex work; Seeing treatable STIs as “normal”, but others like Hepatitis B and C as abnormal, and HIV as the most feared; Recognition of penile symptoms but concerns about sexual health including anal symptoms, such as fistulas and bleeding; good knowledge about HIV but confusions over PEP and PrEP, self-testing, health access to NGO clinics and some hospital clinics but concerns about stigma and discrimination in public clinics generally; and as a result of concerns about public healthcare settings, use of pharmacies for treatment. The data indicate that male refugees from gay repression, as found for refugees from other repressions, face many of the same issues with local variations.

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Accounting for HIV Health Disparities: Risk and Protective Factors Among Older Gay and Bisexual Men

Journal of Aging and Health ◽

10.1177/0898264319848570 ◽

2019 ◽

Vol 32 (7-8) ◽

pp. 677-687 ◽

Cited By ~ 2

Author(s):

Charles A. Emlet ◽

Karen I. Fredriksen-Goldsen ◽

Hyun-Jun Kim ◽

Hyunzee Jung

Keyword(s):

Social Support ◽

Community Engagement ◽

Depressive Symptomatology ◽

Gay And Bisexual Men ◽

Poor Health ◽

Bisexual Men ◽

Physical And Mental Health ◽

Cross Sectional ◽

Study Results ◽

And Bisexual

Objective: This study examines whether disparities exist in poor health and depressive symptomatology among older gay/bisexual men (50+) with ( n = 371) and without ( n = 973) HIV. If so, what risk/promoting factors account for those disparities? Method: These cross-sectional analyses used 2014 data from the Aging With Pride: National Health, Aging, and Sexuality/Gender Study. Results: Those with HIV reported poorer health and more depressive symptomatology accounted for by lower income, resilience and social support, and more lifetime victimization. Poorer health among those with HIV was associated with more chronic conditions. Higher depressive symptomatology was associated with diagnosed anxiety and drug addiction. Community engagement reduced disparities in poor health and depression. Implications: Older gay/bisexual men living with HIV infection are at greater risk for physical and mental health issues. Assessments should be conducted with attention to these risk factors. Interventions for improving social support, resilience, and community engagement are warranted.

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How Do Gay and Bisexual Men Make Up for Missed PrEP Doses, and What Impact Does Missing a Dose Have on Their Subsequent Sexual Behavior?

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.4.275 ◽

2018 ◽

Vol 30 (4) ◽

pp. 275-286 ◽

Cited By ~ 5

Author(s):

Christian Grov ◽

Alexa B. D'Angelo ◽

Anthony W. P. Flynn ◽

Javier Lopez-Rios ◽

David W. Pantalone ◽

...

Keyword(s):

Sexual Behavior ◽

Lived Experiences ◽

Qualitative Interviews ◽

Behavioral Responses ◽

Gay And Bisexual Men ◽

Key Populations ◽

Bisexual Men ◽

Maximum Protection ◽

And Bisexual ◽

Exposure Prophylaxis

HIV pre-exposure prophylaxis (PrEP) is being adopted by members of key populations, such as gay and bisexual men (GBM). Since adherence to a daily PrEP regimen ensures a maximum protection, it is critical to understand GBM's behavioral responses to having missed PrEP doses. We report on qualitative interviews with GBM taking PrEP. We identified three behavioral responses: (1) 59% continued with their next scheduled dose; (2) 49% described “making up” for a missed dose by taking medication as soon as possible; and (3) 11% reported “doubling” the next PrEP dose. Participants provided potentially contradictory narratives about their sexual behavior after a missed dose: (1) 54% described making no changes; (2) 49% described adjusting their sexual behavior to reduce HIV risk; and (3) 10% said their decision would be contingent upon how many doses were missed. For PrEP prescribers, our data provide a useful lens to understand patients' lived experiences with PrEP.

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