Preferences for using condoms, antiretroviral pre-exposure prophylaxis (PrEP) or both prevention options to reduce HIV acquisition among HIV-negative black and Latino men who have sex with men (MSM)

Background:  MSM of color continue to have disproportionate rates of HIV infection. PrEP is an efficacious option for reducing HIV acquisition. Preferences for using condoms, PrEP, or both prevention options were studied among HIV-negative black/African-American and Latino MSM.

Methods: Data are from Messages4Men, a 2014 study of brief prevention messages that included HIV-negative black (n=298) and Latino (n=313) MSM in Chicago, Fort Lauderdale, and Kansas City.  Participants completed a computer-based assessment, which included demographics, recent sexual risk behavior (condom use during anal sex in prior 3 months), as well as their preferences for using condoms, PrEP, or both options in the future.  Bivariate and multivariate analyses were conducted.

Results:  Overall, 43% of men preferred both options compared to 35% and 22% preferring only condoms or PrEP, respectively.  Preferences differed whether men did vs. did not report recent anal sex without a condom (37% vs. 48% both options, 32% vs. 39% condoms only, 31% vs. 13% PrEP only, p<.05). In multivariable models that included recent risk behavior, race/ethnicity, age, education, and city, MSM reporting recent sexual risk behavior (vs. MSM who did not) were more likely to prefer PrEP vs. condoms (OR=3.04, 95% CI=1.98-4.68) and less likely to prefer both options vs. condoms (OR=0.63, 95% CI=0.45-0.88). No differences were found for race/ethnicity, age, or education level.

Conclusions:  Among black and Latino MSM, preferences for using condoms and PrEP varied by reported recent risk behavior. These findings underscore the importance of HIV prevention efforts targeted to MSM by risk behavior.