Concerns regarding PrEP accessibility and affordability among ymsm
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  • YMSM's belief of PrEP accessibility was associated with insurance (b=.24), identifying as Latino (b=.23) or Asian (b=.42), and having heard about PrEP in the past (b=.40). PrEP affordability belief was associated with insurance (b=-.44) and a prior STI (b=.21). Black (b=-.28), Asian (b=-.07), or Other Race/Ethnicity (b=-.52) YMSM were less likely than Whites to report PrEP affordability belief

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  • 1. Concerns regarding PrEP Accessibility and Affordability Among YMSM in the U.S. Jose A. Bauermeister Emily Pingel Steven Meanley Laura Jadwin-Cakmak Gary W. Harper
  • 2. Conflict of Interest  No conflicts to disclose or report.
  • 3. Agenda  Identify how structural conditions may hinder the optimal rollout of PrEP among YMSM in the United States.  Assess how sociodemographic characteristics may be associated with YMSM’s PrEP awareness and accessibility and affordability beliefs.  Consider multilevel strategies that maximize equity in access and use among YMSM interested in considering PrEP as a prevention strategy.
  • 4. The Current PrEP Climate  Truvada was approved as a preventative measure by the FDA in July 2012.  PrEP has been proven highly effective for the prevention of HIV in MSM when paired alongside comprehensive behavioral strategies.  PrEP has had minimal promotion in health service settings  Awareness?  Uncertainty?  Capacity?
  • 5. Sample  Cross-sectional web-survey (July 2012-January 2013)  Identification of unique cases (remove duplicate/frauds)  77% Participation Rate (N=1,507)  Eligibility criteria:      Cis-male Ages 18-24 (M=20.80 years) Single Sex with other men US resident (including Puerto Rico)  Recruitment through advertisements on two social networking sites
  • 6. Sample Characteristics SURVEY PARTICIPANTS BY RACE (N=1,507), Age 18-24 Black Latino White 9% Other race/ethnicity 9% 17% 65%
  • 7. Sample Characteristics N=1,507 N(%) Residentially Unstable (30 days) 210 (13.9%) Ever sent to jail/prison 113 (7.5%) Covered by any insurance 1221 (81.0%) Sexual Behaviors Sexually Active in prior 2 months 1062 (70.5%) URAI in past 2 months 427 (28.3%) Prior HIV/STI (lifetime) HIV-positive Other Sexually-Transmitted Infection 19 (1.3%) 224 (14.8%)
  • 8. Who has heard of PrEP?  27% of the sample had heard about PrEP in the past. Multivariate Logistic Regression OR 95% CI Sig. Age 1.13 (1.05, 1.21) .001 Black 1.09 (.71, 1.68) .696 Latino .93 (.67, 1.29) .660 Asian/Pacific Islander 1.04 (.57, 1.89) .908 Multiracial 1.02 (.54, 1.93) .964 Other .68 (.22, 2.09) .497 Educational Attainment 1.19 (1.07, 1.34) .002 Residentially Unstable (30 days) 1.37 (.98, 1.91) .069 Ever sent to jail/prison .63 (.38, 1.03) .067 Covered by insurance 1.50 (1.07, 2.09) .018 URAI in past 2 months 1.20 (.93, 1.57) .164 Prior STI/HIV 1.79 (1.31, 2.43) .001 Race/Ethnicity
  • 9. PrEP Perceptions & Beliefs  Among those who had heard about PrEP (N=410):  Over a third (36.4%) agreed that they would not take PrEP due to side effect concerns.  (M = 2.30, SD = .93)  Less than half (48%) reported knowing how to access PrEP if they wanted it.  (M = 2.47, SD = 1.06)  YMSM were most likely to agree or strongly agree (61.2%) that they could not afford to take PrEP.  (M = 2.78, SD = .92). Beliefs ascertained on 4-point scale (1=Strongly Disagree; 4 = Strongly Agree)
  • 10. I would not take PrEP drugs because I am concerned about their side effects. N=410 I could not afford PrEP drugs. B SE Sig. b SE Sig. (Constant) 1.75 .56 .002 2.38 .53 .001 Age .02 .03 .453 .05 .03 .085 Black .57 .17 .001 .05 .16 .771 Latino .31 .13 .018 -.06 .12 .617 Asian/Pacific Islander .31 .23 .184 -.71 .22 .002 Multiracial .40 .25 .115 .21 .24 .381 Other -.37 .48 .444 -.67 .45 .141 Educational Attainment -.04 .05 .365 -.05 .04 .239 Residentially Unstable (30 days) .04 .13 .761 .13 .12 .306 Ever sent to jail/prison .16 .21 .449 .23 .20 .246 Covered by insurance .22 .14 .116 -.53 .13 .001 URAI in past 2 months -.16 .10 .112 -.05 .10 .585 Prior STI/HIV -.02 .11 .846 .33 .11 .002 Race/Ethnicity
  • 11. Addressing Individual Barriers  Knowledge as a barrier  YMSM knowing about and understanding PrEP  What it is  How it works  Adequacy for me  How to get it  Perceived barriers  Racial/ethnic differences in side effect beliefs  Affordability based on insurance and risk profiles  Raise YMSM self-efficacy & access  PrEP as a viable option  Getting PrEP without insurance
  • 12. Connecting to PrEP  More PrEP advocacy in the HIV/AIDS political realm  Resistance to funding PrEP access and education  Insurance coverage  Aiding HIV/AIDS Service Providers aid YMSM to consider whether PrEP is a viable option in their lives
  • 13. A roadmap to PREP…
  • 14. Contact information jbauerme@umich.edu