WP 61 General Medication Adherence, Health Insurance Type, and Recent Condomless Sex: Implications for PrEP Implementation Among HIV-Uninfected Black/African American and Latino MSM in Three US Cities

Wednesday, September 21, 2016
Galleria Exhibit Hall
Alexa Peterson, B.A, Gustavus Adolphus College, St. Peter, MN, Gordon Mansergh, PhD, Division of HIV/AIDS Prevention, CDC, Atlanta, GA, Jeff Herbst, PhD, Centers for Disease Control and Prevention, Matthew Mimiaga, ScD, MPH, Brown University, Nicole Pitts, BS, ICF International, Damian Denson, PhD, MPH, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Stewart Landers, PhD, John Snow Inc. and Jeremy Holman, PhD, Health Resources in Action

Background:  Black and Latino men who have sex with men (MSM) are disproportionately affected by HIV/STDs in the United States. The effectiveness of HIV prevention methods like pre-exposure prophylaxis (PrEP) is challenged by poor medication adherence.  Outside of clinical trials, little is known about real-world, medication adherence among black and Latino MSM and implications for PrEP implementation. 

Methods:  We analyzed survey results from 605 HIV-uninfected black and Latino MSM in Chicago, IL, Fort Lauderdale, FL, and Kansas City, MO, in the 2014 Messages4Men Study. A four-item scale assessed past general medication adherence, and men were asked about current health insurance status. Summed adherence item responses compared no vs. any past general medication adherence problems, and public/other and no insurance vs. private health insurance. Multivariable logistic regression models tested associations of demographic variables, condomless anal sex (past 3 months), and health insurance type with general medication adherence problems. 

Results:  The sample was 48% black and 52% Latino; 52% reported recent condomless anal sex; 61% reported general medication adherence problems; and 48% had private insurance, 24% public/other (mostly Medicare/Medicaid), and 28% no health insurance. In multivariable regression analysis, recent condomless anal sex (Adjusted Odds Ratio [AOR]=2.57, 95% Confidence Interval [CI]=1.78-3.73) and public/other (vs. private) insurance (AOR=2.27, 95% CI=1.35-3.82) were associated with general medication adherence problems in the past. 

Conclusions:  Recent condomless sex and public/other insurance were associated with general medication adherence problems among black and Latino MSM. These findings suggest that the public health community and practitioners may particularly need to address adherence issues and insurance access when implementing PrEP in this population.