PrEP use and stigma among a sample of older adults in Columbus,Ohio

Abstract

Introduction

Despite older adults (age ≥50 years) continuing to account for 1 in 6 new HIV diagnoses, the majority of research has focused on young adults. Assessing PrEP use and stigma among this understudied population is key to achieving the U.S.’s goals of Ending the HIV Epidemic, a federal initiative focusing on reducing new HIV infections by at least 90% by 2030.

Methods

Data for this analysis came from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio. Multiple logistic and linear regression models were used to examine the associations between sociodemographic factors and past 6-month PrEP use, PrEP stigma, and concurrent use of PrEP and other prevention methods, adjusting for known confounders.

Results

Overall, 93 (11.7%) participants reported past 6-month PrEP use. Transgender women (aOR = 6.90; 95% CI: 2.19, 21.72), cisgender gay men (aOR = 5.58; 95% CI: 2.49, 12.50), cisgender lesbians (aOR = 2.24; 95% CI: 1.05, 4.80), and those living with family members or roommates (aOR = 6.59; 95% CI: 3.49, 12.45) were each more likely to report past 6-month PrEP use relative to cisgender women, heterosexuals, and those living with a spouse/partner, respectively. Relative to cisgender women, PrEP-related stigma was lower among transgender women (β = −5.05; 95% CI: −8.44, −1.66) and higher among cisgender men (β = 1.96; 95% CI: 0.46, 3.46).

Conclusion

Future research should aim to continue developing a firm understanding of PrEP use and stigma among older adults to reduce HIV risk among this population and to understand unique needs of sub-populations of older adults.

Keywords

Older adults HIV PrEP pre-exposure prophylaxis stigma

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References

Bosh

Hall

Eastham

, et al. Estimated annual number of HIV infections––United States, 1981–2019. MMWR 2021; 70(22): 801–806.

Morgan

Moran

Ryan

, et al. Threefold increase in PrEP uptake over time with high adherence among young men who have sex with men in Chicago. AIDS Behav 2018; 22(11): 3637–3644.

Centers for Disease Control and Prevention . HIV Surveillance Report. Atlanta, GA: CDC; 2020.

HIV.gov . U.S. statistics. Available at: https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics (2021; accessed 8 March 2022).

Centers for Disease Control and Prevention . HIV and Older Americans. Available at: https://www.cdc.gov/hiv/group/age/olderamericans/index.html (2021; accessed 12 April 2021).

Grant

Lama

Anderson

, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363(27): 2587–2599.

CDC . Pre-exposure prophylaxis. PrEP. Available at: https://www.cdc.gov/hiv/risk/prep/ (2018; accessed 15 February 2019).

Centers for Disease Control and Prevention . PrEP for HIV prevention in the U.S.. Available at: https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html (2020; accessed March 8 2022)

Hoagland

Moreira

De Boni

, et al. High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project. J Int AIDS Soc 2017; 20(1): 1–14.

10.

Liu

Cohen

Follansbee

, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. Plos Med 2014; 11(3): e1001613.

11.

Finlayson

Cha

Xia

, et al. Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men - 20 urban areas, 2014 and 2017. MMWR Morb Mortal Wkly Rep 2019; 68(27): 597–603.

12.

Lindau

Schumm

Laumann

, et al. A study of sexuality and health among older adults in the United States. New Engl J Med 2007; 357(8): 762–774.

13.

Tuddenham

Page

Chaulk

, et al. Patients fifty years and older attending two sexually transmitted disease clinics in Baltimore, Maryland. Int Journal STD AIDS 2017; 28(4): 330–344.

14.

Savasta

. HIV: associated transmission risks in older adults–an integrative review of the literature. J Assoc Nurses AIDS Care 2004; 15(1): 50–59.

15.

Centers for Disease Control and Prevention . Ending the HIV epidemic in the U.S. (EHE). Atlanta, GA: Dept of Health and Human Services; 2021.

16.

Lee

Park

, et al. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med 2018; 5(4): 249–255.

17.

Morgan

Ryan

Moran

, et al. Trends in PrEP uptake, adherence, and discontinuation among YMSM in Chicago. Boston, MA: CROI; 2018.

18.

van Dijk

de Wit

JBF

Guadamuz

, et al. Slow uptake of PrEP: behavioral predictors and the influence of price on PrEP uptake among MSM with a high interest in PrEP. AIDS Behav 2021; 25(8): 2382–2390.

19.

Okafor

Gorbach

Ragsdale

, et al. Correlates of preexposure prophylaxis (PrEP) use among men who have sex with men (MSM) in Los Angeles, California. J Urban Health 2017; 94(5): 710–715.

20.

Mustanski

Ryan

Hayford

, et al. Geographic and individual associations with PrEP stigma: results from the RADAR cohort of diverse young men who have sex with men and transgender women. AIDS Behavior 2018; 22(9): 3044–3056.

21.

CDC . HIV and youth. Available at: https://www.cdc.gov/hiv/group/age/youth/index.html (2019; accessed 10 April 2019).

22.

Huang

Zhu

Smith

, et al. HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. MMWR 2018; 67(41): 1147–1150.

23.

Hong

Horvath

Stephenson

, et al. PrEP use and persistence among young sexual minority men 17–24 years old during the COVID-19 pandemic. AIDS Behav 2022; 26(3): 631–638.

24.

25.

Gott

Hinchliff

Galena

. General practitioner attitudes to discussing sexual health issues with older people. Soc Sci Med 2004; 58(11): 2093–2103.

26.

Dunlop

Manheim

Song

, et al. Gender and ethnic/racial disparities in health care utilization among older adults. J Gerontol Ser B 2002; 57(4): S221–S233.

27.

Ezhova

Savidge

Bonnett

, et al. Barriers to older adults seeking sexual health advice and treatment: a scoping review. Int J Nurs Stud 2020; 107: 103566.

28.

Dubov

Galbo

Altice

, et al. Stigma and shame experiences by MSM who take PrEP for HIV prevention: a qualitative study. Am J Men’s Health 2018; 12(6): 1843–1854.

29.

Hascher

Jaiswal

Lorenzo

, et al. ‘Why aren’t you on PrEP? You’re a gay man’: reification of HIV ‘risk’ influences perception and behaviour of young sexual minority men and medical providers. Cult Health Sexuality 2021: 1–15.

30.

Brooks

Landrian

Nieto

, et al. Experiences of anticipated and enacted pre-exposure prophylaxis (PrEP) stigma among latino MSM in Los Angeles. AIDS Behav 2019; 23(7): 1964–1973.

31.

Feldman

Romine

Bockting

. HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample. J Homosexuality 2014; 61(11): 1558–1588.

32.

Wilson

Garofalo

Harris

, et al. Transgender female youth and sex work: HIV risk and a comparison of life factors related to engagement in sex work. AIDS Behav 2009; 13(5): 902–913.

33.

Kim

Feyissa

. Conceptualizing “family” and the role of “chosen family” within the LGBTQ+ refugee community: a text network graph analysis. Healthcare (Basel) 2021; 9(4): 369.