How Black men who have sex with men in New York City understand, talk about, and engage with pre-exposure prophylaxis (PrEP)

Background: Black men who have sex with men (BMSM) have the highest HIV incidence rates in the U.S. and it is vital to explore how new prevention approaches might reduce those rates. Research has demonstrated the clinical effectiveness of pre-exposure prophylaxis (PrEP), but little is known about how BMSM understand, talk about, and experience PrEP.

Methods: BMSM in New York City (n=28) completed three in-depth interviews each for a total of 270 minutes of data. Fourteen key informants (e.g. community leaders and service providers) also participated. We taped, transcribed, and analyzed interviews to explore how individuals talked about their understanding of, and potential barriers to, using PrEP.   

Results: Individuals reported a number of factors influencing the likelihood of PrEP use. First, men disliked taking medication and felt a daily pill was “too much commitment” just for sex, particularly when they were healthy. Second, men reported that taking a medication associated with HIV might generate stigma. Third, some participants believed unprotected sex would increase if people took PrEP, while others highlighted that PrEP doesn’t protect against other STIs. Such conclusions led participants to question PrEP’s utility. Lastly, participants thought PrEP would be a successful strategy for others, but not for themselves.

Conclusion: BMSM are listed as a key population in the U.S. National HIV/AIDS Strategy, yet few individuals believed PrEP would be personally helpful. Our research indicates the urgent need to raise awareness and address beliefs and attitudes that could be substantial barriers to the scale-up and implementation of PrEP-related services.