PrEP Factors

What influences the use of the HIV prevention tool among MSM?

by Justin B. Terry-Smith

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PrEP, PrEP and more PrEP. PrEP has been approved by the Food and Drug Administration since 2012 and prevents the transmission of HIV from one person to another up to ninety-two percent, with others saying ninety-nine percent.

Men who have sex with men whose sexual activities were categorized as high risk, a demographic that is most vulnerable to HIV infection, was one of the populations for which PrEP was first indicated. However, not everyone who is gay or bi, or same-gender-loving, has heard of PrEP.

While in Chicago for an event that catered to MSM, I noticed a young gay man who seemed very curious to know others in my group. So I befriended him because I was curious to know where he was in his life and where his head was at. He was an early twenty-something and I asked his profession and he said he was a server at a restaurant and had dropped out of college. I then asked, “Have you heard of PrEP?” He replied, “No, what is PrEP?” I was shocked and surprised. I wondered why this young man had not heard of PrEP.

When I started my doctoral study and thought about a possible public health dissertation topic, I wanted to focus on something other than HIV. There were several options such as childhood obesity, drug abuse, smoking, etc., but my mind would not stop thinking about that young gay man who had no idea what PrEP was. I couldn’t get him out of my head.

At the end of my classes I began the dissertation process. I started listing possible factors that might influence a MSM to use PrEP. I had over twenty factors that I decreased to four. In my cross-sectional study I was determined to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM.

After the dissertation was all said and done I found out a lot. My abstract starts out with stating: “Prevention is key to keeping men who have sex with men (MSM) protected from Human Immunodeficiency Virus (HIV). Despite new and innovative HIV prevention resources such as pre-exposure prophylaxis (PrEP), factors such as education level, employment status, number of sexual partners, and access to health resources may inhibit certain populations from using PrEP. The purpose of this cross-sectional study was to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM. The fundamental cause theory was used to examine how socioeconomic barriers are associated with the use of PrEP among MSM in the United States. Secondary data from 217 surveys were collected from the Public Library of Science. Findings from multiple regression analyses indicated that employment status, access to health resources, and number of sexual partners were not associated with use of PrEP among MSM. Those who had at least some high school or a high school diploma were 3.98 times more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 3.98, p = .048). Those who had some college were 6.91 more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 6.91, p = .028). Findings may be used to assist public health professionals in identifying factors that prevent the use of PrEP. By addressing these health threats, and social barriers, specialists could have the ability to increase HIV prevention activity in populations that are more susceptible to being infected with HIV and may decrease HIV infections not only within the MSM population but also in other populations.”

We need to research several other factors to explain why MSMs are not using PrEP as much as they should. For example, believe it or not in this country there is still a language barrier. There needs to be a bigger push for public health organizations to market towards the communities of color, and particularly more of a marketing push in language and culture to make sure that Latino MSM are more informed; after all English is not the only language we speak in this country. According to CNN (2018) the Latino/Hispanic population makes up the largest minority in the United States. The Census Bureau predicts that in the year 2060 the Latino/Hispanic community will make up 28% of the total population at 119 million residences. Today the Latino/Hispanic community is estimated to have 55 million persons residing in the United States, which is second to Mexico in Latino/Hispanic residences worldwide. Also, the Black community needs to be more informed on PrEP and its benefits. These are populations vulnerable to HIV infection, especially if you look at MSM of color, being a minority within a minority within a minority. According to the CDC, “Black/African Americana gay, bisexual, and other MSM are more affected by HIV than any other group in the United States. In 2016, Black/African American gay and bisexual men accounted for 26% (10,223) of the 39,782 new HIV diagnoses in the United States.”

We need to make PrEP more accessible to populations of color, especially to those who are uninsured and underinsured. PrEP is a pretty penny for those that do not have the income or insurance to go on the prevention regimen. The only factor that my research found that influenced a MSM to go on PrEP was higher education. The more education a MSM had, the more they were influenced to go on PrEP. The other factors of employment status, number of sexual partners, and access to health resources turned out to be not significant influences.


Terry-Smith, J. B. (2018). Factors Influencing Use of Pre-Exposure Prophylaxis Among Men Who Have Sex With Men. Retrieved from https://scholarworks.waldenu.edu/dissertations/5273/.


Justin B. Terry-Smith writes the Just*in Time column for A&U.