University of Massachusetts Medical School Faculty Publications
Title
Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men
UMMS Affiliation
Department of Quantitative Health Sciences; Center for Health Policy and Research, Commonwealth Medicine
Publication Date
11-1-2017
Document Type
Article
Disciplines
Community Health and Preventive Medicine | Health Economics | Health Policy | Health Services Administration | Immune System Diseases | Virus Diseases
Abstract
Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.
Keywords
HIV, PrEP, YMSM, healthcare
DOI of Published Version
10.1089/apc.2017.0171
Source
AIDS Patient Care STDS. 2017 Nov;31(11):470-478. doi: 10.1089/apc.2017.0171. Link to article on publisher's site
Related Resources
Journal/Book/Conference Title
AIDS patient care and STDs
PubMed ID
29087744
Repository Citation
Marks, Sarah J.; Merchant, Roland C.; Clark, Melissa A.; Liu, Tao; Rosenberger, Joshua G.; Bauermeister, Jose; and Mayer, Kenneth H., "Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men" (2017). University of Massachusetts Medical School Faculty Publications. 1381.
https://escholarship.umassmed.edu/faculty_pubs/1381