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11 The Centers for Disease Control and Prevention has provided guidelines that reflect input from providers, HIV patients, partners, and affected communities for use of PrEP.
On July 16, 2012, the US Food and Drug Administration approved Truvada in combination with condom use and other safer sex practices to reduce the risk of sexually acquired HIV-infection as a form of PrEP. 9 Black MSM continue to be highly impacted in Los Angeles County (LAC) as well, where the HIV incidence rate for blacks was three-times the rate for whites and Latinos. 8 Current estimates indicate that 24.9% of black MSM who are seronegative at age 18 will become HIV-positive by age 25 3 however, the introduction of PrEP into this community may make a critical difference, especially since younger black MSM may be more likely to accept PrEP than older black MSM. 7 In fact, recent data from a 21-city surveillance study shows that YBMSM are almost four-times more likely to be HIV infected than their Hispanic and white peers. 5 YBMSM accounted for more new HIV infections than any other age and racial group of MSM. 6 Overall, YBMSM accounted for 55% of new HIV infections among young MSM and 45% among black MSM. 3, 4 According to a recent CDC report on estimates for HIV incidence, YBMSM are at the forefront of new HIV infections, 5 and there was a 22% increase in HIV incidence among young MSM from 2008 to 2010. Young black men who have sex with men (YBMSM) are at extremely high risk for HIV infection in the US. 1 In light of this expanding range of options, each of which may be used as an element of a “tool-kit” to help reduce new HIV infections, many healthcare professionals are open to using PrEP and PEP as part of a “combination prevention” 2 strategy, particularly with individuals who are considered to be at high risk for HIV infection. Biomedical interventions incorporate a biological and/or medical component to prevent HIV transmission, such as PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis), TasP (treatment as prevention), and others. However, today there are still more options, some carrying more complex biomedical implications. Gay men have long been faced with a complex set of sexual health options, including condom use, negotiated safety, partner selection, and abstinence. W ith the widening array of HIV prevention options now available, the days of a “one size fits all” approach are gone. Such “prevention navigation” could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM.
We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention (2) expectations about PrEP, sexual behavior, and stigma (3) gossip, disclosure, and “spreading the word” about PrEP and PEP and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. Yet participants also framed PrEP and PEP as valuable new options within an expanded “tool kit” of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Participants had widely divergent levels of knowledge about these prevention methods. Interviews were analyzed using a grounded theory approach. We report results of 24 dyadic qualitative interviews ( N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM).