Half of all gay black men are diagnosed with HIV despite highly effective prevention treatments – why?

At a pharmacy in Iowa, a 42-year-old gay black man couldn't find a medicine he needed. The pharmacist, a white woman, told him they didn't have that medication in stock. But while he was waiting to pay for his other purchases, he saw one other customer put the medication he had just ordered on the counter.

“I felt really bad,” he said. “I think when people associate their prejudices with their profession, it makes it harder to access (health) services.”

These services include PrEP or Pre-exposure prophylaxisa highly effective prescription medicine that stops the spread of HIV.

Black gay and bisexual men about 38% of the estimated 37,981 latest HIV diagnoses within the United States in 2022. The Centers for Disease Control and Prevention estimate that About 50% of those men will receive an HIV diagnosis during their lifetime.

Although black gay and bisexual men are disproportionately affected by HIV, they’ve considered one of the lowest PEP usage rates in all age groups. Many of them live within the South, where most individuals living with HIV live within the United States, but PrEP uptake may be very low on account of stigma, cost, and homophobia. Other barriers include lack of trust within the health care system, discrimination, poverty, and lack of information amongst doctors about PrEP.

PrEP faces significant barriers to widespread use amongst probably the most vulnerable populations. In 2022 36% of the 1.2 million people who may benefit from PrEP were prescribed the medication. Public health researchers study why Black gay and bisexual men have low access to PrEP in Iowa – a rural state with rising HIV infection rates, particularly amongst sexual and gender minorities. We recently published a study that highlighted Some ways to enhance prevention.

Trust and discrimination

Non-Hispanic blacks make up only 4% of Iowa’s estimated 3.1 million residents. However, they made up 24% of individuals in Iowa might be living with HIV in 2022.

A report from the Iowa Department of Health and Human Services found that just over 23% of individuals in Iowa who need PrEP had lively recipes in 2021Another report found that a government program called TelePrEP, which goals to expand access to PrEP through telemedicine, significant differences in the beginning of treatmentOnly 10% of people that began PrEP through this system were black. In contrast, 83% of those that began TelePrEP were white.

To higher understand the aspects that make it difficult or easier for black gay and bisexual men in Iowa to access PEP, interviewed 12 HIV-negative community members about their experiences with the drug. They ranged in age from 20 to 42 and lived in Johnson and Black Hawk counties, which have a few of the highest HIV infection rates within the state. We recruited them through dating apps, social media platforms and native organizations.

Some men feared that using PrEP could lead on to mistrust of their intimate relationships.

“[F]or you enter into a sexual relationship with a partner, there has to be a certain level of trust,” said one participant. “The fact that you have to take drugs before engaging in sexual activity shows that you do not trust your partner.”

Other men feared they’d be stigmatized and discriminated against. Some people within the gay community associate taking PrEP with sexual promiscuity and are subsequently afraid of being judged for taking the drug.

“If you don’t have sex, why should you take PrEP?” asked one participant.

Some men also had negative experiences with the health care system, including being denied access to medication due to their race.

Most men felt that inadequate medical insurance was a significant barrier to PrEP use. Five of our participants had no medical insurance and only two had public medical insurance. Some of the participants were students and had limited access to non-public insurance.

“There are a lot of people who are uninsured,” said one participant. “It would be nice if the government could actually make it accessible to everyone – just like the HIV self-test.”

Many of the lads had little or no prior knowledge of PrEP. “Yes, I don't know much about PrEP,” said one participant. “That's actually why I decided to take part in this study, to actually learn more about it.”

Some men were afraid of the possible uncomfortable side effects of the drugs. One participant was concerned in regards to the risk of developing cancer from long-term use of the drugs. There are no evidence that PrEP increases the danger of cancer, but a An HIV infection can.

Finally, some men also fearful about how effective the drugs were and whether or not they could depend on them if their partner was HIV-positive. However, when taken appropriately, PrEP can Reduce the danger of sexually transmitted HIV infection by about 99%.

Populations surveyed for other studies expressed similar concerns about treatment, including Transgender women in Colombia And gay and bisexual men within the Midwest of the USA.

Improving access to PrEP

Despite the numerous barriers faced by gay and bisexual black men in Iowa in accessing PrEP, possible solutions highlighted.

Most of our participants agreed that educating the general public about PrEP and raising public awareness about health issues is crucial. “You could reach people through the radio and flyers. You could put them out at the hairdresser, the barbershop, the supermarket,” one participant suggested. “I think those are public places that are really accessible to people.”

Some emphasized the importance of developing culturally sensitive educational programs on different platforms to raised engage the community. One participant said, “Doing seminars and focus group discussions and educating people about PrEP could really help.”

Participants also suggested that making PrEP available no matter insurance status would help reduce financial barriers to accessing this preventive medication. For example, free or low-cost access to all types of PrEP could possibly be a game-changer, especially for low-income people in danger for HIV.

Our participants also emphasized the role that trusted physicians could play.

“To convince me to start something like PrEP, it would have to come from someone I already trust,” said one participant. “Their expertise and personal knowledge of my health condition would make their advice particularly compelling.”