Trends in Attitudes and Use of Pre-Exposure Prophylaxis Among Adult MSM and Transgender Women at Risk of HIV from 2012-2022
Creators: name: Mexan Mapouka
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2023

description: Currently there are several FDA-approved drugs that can be taken as pre-exposure prophylaxis (PrEP), which can be effective in preventing HIV when taken as prescribed (PrEP Daily Team, 2022). Despite the availability of PrEP, utilization remains low, particularly among sexual and gender minorities (CDC, 2021). In this paper, we attempt to describe current trends in access to PrEP among adult men who have sex with men (MSM) and transgender women in the United States from 2012-2022.The literature review describes disparities of PrEP knowledge and use which can describe barriers to PrEP access. 
There was minimal data available for transgender women and subgroups of MSM including homosexual, bisexual, or pansexual men. The National HIV Behavioral Surveillance (NHBS) measures HIV prevention behaviors among high risk populations including persons who inject drugs, MSM, and high risk heterosexually active persons (CDC, 2022). The first surveillance of transgender women occurred from 2019-2020. This report in conjunction with the most recent full report on MSM in 2017 were analyzed to ensure equivalent inclusion,  exclusion, and measurement criteria in both groups. Data on subgroups of MSM were not included. As a result, data on PrEP trends and utilization among MSM and transgender women were not available prior to 2017 and 2019 respectively. While trends could not be assessed, these NHBS reports can be used to develop appropriate interventions that increase PrEP awareness and use while destigmatizing its use. 
Measures examined in the HIV Behavioral Surveillance (NHBS) 2017 MSM report and 2019-2020 transgender women report include gender identity, sexual activity, PrEP awareness, PrEP use, race/ethnicity, and age in HIV negative participants. The data analysis included 902 HIV negative transgender women who participated in the 2019-2020 cycle and 7,125 HIV negative MSM from the 2017 cycle of surveillance. Despite a high proportion of MSM (87.1%) and transgender women (90.2%) who had heard of PrEP, approximately one in four MSM (24.0%) and transgender women (27.2%) reported using PrEP within the 12 months prior to being interviewed. Black (OR: 0.52; 95CI: 0.45, 0.60), American Indian/Alaska Native (OR: 0.37; 95CI: 0.17, 0.83) and Hispanic (OR: 0.60; 95CI: 0.53, 0.69) MSM were significantly less likely to use PrEP than White participants.
 Due to limited available literature and data on PrEP use and HIV prevention among transgender and MSM subpopulations, we proposed self-administered, web-based questionnaires for additional data collection that is inclusive of gender and sexual identity. Overall, this paper highlights the disproportionate use of PrEP and the paucity of available data on sexual minorities, especially transgender women and MSM subpopulations. Future research would need to address this gap so that trends in PrEP use and attitudes in gender and sexual minority groups at increased risk of HIV can be characterized.