Abstract of Distinction: Economic Disparities in Information Source, Willingness, and Usage of Pre-Exposure Prophylaxis (PrEP) Among Young Latino MSM in San Antonio, TX

Introduction: Texas (TX) has one of the highest HIV prevalence rates for Latinos (CDC, 2016) and a highly HIV infectious cluster was recently identified among Young Latino Men who have Sex with Men (YLMSM) ages 20-29 in San Antonio (Monterosso et al., 2017). PrEP has been promoted as an HIV biomedical intervention, but limited research on PrEP has focused on Latinos (García & Harris, 2017), particularly low-income YLMSM. This study explores the economic disparities in information source, willingness, and usage of PrEP among YLMSM.

Methods: YLMSM ages 21-30 in San Antonio, TX were recruited through convenience-based sampling at gay venues and social applications. Of 127 participants who self-reported HIV negative, 54.3% had an annual household income of more than $50,000, 66.9% were aware of PrEP, and 44.9% were taking PrEP. All participants were asked about their willingness or current use of PrEP, but only participants aware of PrEP were asked to identify their source of information. Chi-square and multiple regression analyses were conducted to test the significant differences in PrEP-related measures between higher ($50,000 or above) and lower ($49,999 or below) income groups.

Results: Chi-square test results with a significant level of 0.05, which was further supported by multiple regression analyses controlling for age, indicated that income differences existed for information sources, willingness, and usage of PrEP. Higher-income YLMSM aware of PrEP reported significant higher rates of taking PrEP (85% vs. 5%) and receiving PrEP information from their sexual partner (71% vs. 21%) and the Internet (74% vs. 37%). Lower-income YLMSM currently not on PrEP reported significant lower level of willingness to take PrEP daily (51% vs. 100%) and concerns associated with PrEP-related side effects such as “nausea, dizziness, vomit, diarrhea, or stomach pain” (12% vs. 77%), “liver damage” (4% vs. 54%), and “kidney damage” (4% vs. 46%). Further, higher-income YLMSM not on PrEP reported significant higher levels of concern that taking PrEP might cause people to stigmatize them as gay (100% vs. 67%) and sexually promiscuous (100% vs. 65%).

Conclusions: This study documents the inequitable access and usage of PrEP across different economic groups among YLMSM and offers evidence for strengthening efforts for young YLMSM to consider, access, and adhere to PrEP as a viable biomedical intervention to prevent the risk of HIV transmission. Efforts promoting PrEP for lower-income YLMSM need to extend beyond the Internet and address issues related to taking a daily pill and side effects. PrEP-related stigmas hinder higher-income YLMSM from taking PrEP, but sexual partners are an important source of support for PrEP users.