142nd APHA Annual Meeting and Exposition

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PrEP Acceptability, Access and Predicted User Behaviors in US Male Sex Workers: Implications for Effectiveness

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 11:30 AM - 11:45 AM

Kristen Underhill, D.Phil., J.D. , Yale Law School/ Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT
Kathleen Morrow, PhD , Miriam Hospital, Brown University, Providence, RI
Caroline Kuo, DPhil , Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
Richard Holcomb , Project Weber, Providence, RI
Don Operario, PhD , Lifespan/Tufts/Brown Center for AIDS Research, Brown University, Providence, RI
Kenneth Mayer, MD , The Fenway Institute, Fenway Health, Boston, MA
Audio (mp3) recording Recorded Presentation (mp4)
BACKGROUND: Tenofovir with emtricitabine is efficacious as pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM).  Men who sell sex experience HIV risk due to unprotected sex, STIs, numbers of partners, and drug use including injection. Little is known about PrEP acceptability in this group. We interviewed male sex workers to understand PrEP acceptability and predicted user behaviors.

METHODS: We conducted in-depth interviews with n=31 male sex workers in Providence, RI. Men were adults of self-reported uninfected/unknown HIV status, reporting recent sex work and unprotected anal sex with a man of infected/unknown HIV status. Interviews discussed PrEP acceptability, healthcare access, adherence, and risk compensation.

RESULTS: Few men had heard of PrEP; none had used PrEP or PEP. Most were interested in PrEP, but lacked health insurance and were uncomfortable disclosing risk behavior to clinicians. Most were unemployed or disabled, making PrEP unaffordable. Predicted adherence was high depending on perceived HIV risk and PrEP benefit, but obstacles included inconsistent routines, need for covert use, alternating low-risk and high-risk periods due to drug use, and side effects. Some men predicted increased personal risk-taking, more clients, and income related to PrEP use; others predicted reduced risk-taking due to empowerment associated with PrEP.  Some predicted no behavior change.

CONCLUSIONS: Male sex workers are interested in PrEP and could benefit from implementation.  But effectiveness will depend on outreach, access to cost assistance, improved access to health care in settings where they are comfortable disclosing MSM behavior, addressing adherence obstacles, and population-specific behavioral counseling.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe knowledge of biomedical HIV prevention methods, especially PrEP and PEP, among male sex workers in the US. Identify potential access barriers for male sex workers who wish to use PrEP, including access to clinical providers and HIV testing services. Analyze willingness to use PrEP, predicted PrEP adherence, and predicted adjustments in sexual risk behavior (i.e., risk compensation behavior) among male sex workers who wish to use PrEP.

Keyword(s): HIV/AIDS, Sex Workers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I served as a member of the study team including collection, analysis, and write up of data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5115.0: Pre-Exposure Prophylaxis and HIV