Thomas H. F. Whitfield

Uptake of Hiv Pre-exposure Prophylaxis (prep) in a National Cohort of Gay and Bisexual Men in the United States

Objectives: The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational pre-exposure prophylaxis (PrEP) Cascade involving 5 stages based on the Transtheoretical Model of Change. Methods: We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. Results: Nearly all (89%) participants were sexually active in the past 3 months and 65% met Centers for Disease Control criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (stage 5). Conclusions: The large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.

Preferences for Sexual Health Smartphone App Features Among Gay and Bisexual Men

Given the popularity of geosocial networking applications (“apps”) among gay, bisexual, and other men who have sex with men (GBMSM), this study sought to examine GBMSM’s willingness to use sexual health and behavior tracking features if integrated within apps they are already using to meet sexual partners. Most GBMSM (91%) recruited on a popular app reported interest in one or more sexual health app features, including features to find LGBT-friendly providers (83%), receive lab results (68%), schedule appointment reminders (67%), chat with a healthcare provider (59%), and receive medication reminder alerts (42%). Fewer GBMSM were interested in tracking and receiving feedback on their sexual behavior (35%) and substance use (24%). Our data suggest that integrating sexual health and behavior tracking features for GBMSM who use apps could be promising in engaging them in HIV prevention interventions. Further research is needed on GBMSM’s perspectives about potential barriers in using such features.