Medical Technology

In the Military, Latino and Black MSM Have More Access to PrEP

Men on active duty who have sex with men (MSM), Black and Latino military personnel are at least three times more likely to receive HIV pre-exposure prophylaxis (PrEP) than their White counterparts, as per new survey results.

“In the civilian population, we see a lot more challenges and barriers [to access PrEP in our high-risk populations — people within the MSM which are primarily people of color,” Colten Staten, RN, study author, told Medscape Medical News. The findings show “what happens when access to PrEP prescriptions becomes less of an issue for active-duty service personnel,” he said, noting that all active duty military personnel have free medical care through the Military Health System.

The survey was presented at the Association of Nurses in AIDS Care2021 conference on November 11 and was available for five days in 2020. All participants were 18 years old, were identified as MSM, and were active-duty members of the United States military.

The study included 36% of the 354 male participants. 25.4% were Black; 20.3% were Latino; 6.5% were Asian/Pacific Islanders and 5.6% were Native Americans. Furthermore, 69.5% of the men who were part of the study identified themselves as gay, 23.4% as bisexual, and 7.6 percent were straight. 17.2 percent of the respondents had a partner who was HIV positive. 19.2 percent of respondents did not know about their partner’s status.

Black participants were three times more likely to be prescribed PrEP than White service members ( P < .001). Latino respondents were 3.6 times more likely than White counterparts to receive PrEP ( P =.003). Participants whose partner disclosed an HIV-positive status were 7.1 times more likely to receive a prescription for PrEP than those who did know the status of their partner ( P = .013) and bisexual respondents were 2.1 times less likely to receive a prescription for PrEP than those who declared themselves gay ( P = .04).

While the study demonstrates that populations at risk are receiving PrEP within the military but research suggests that PrEP is not being prescribed to this population, Staten said. A study from 2018 published in the Morbidity and Mortality Weekly Report revealed that 20.9% US military personnel were at an elevated risk of HIV infection. About 12,000 military personnel are eligible for PrEP prescriptions. From February 1, 2014 until June 10 in 2016 Truvada was prescribed to 759 military members. The report from 2018 revealed that about 350 active duty service members are diagnosed with HIV each year, with a the majority of new infections occurring in Black people.

The study suggests that prescriptions are reaching people who need them, but Justin Alves, RN ACRN, CARN, a Boston Medical Center nurse who was not involved in the study, said “the most troubling aspect” is that it isn’t occurring in the manner that we would like. In an interview with Medscape Medical News , Justin Alves, RN and ACRN, explained that the study suggested that prescriptions are being delivered to these populations. Alves stated that this study is the beginning of a lot more research. It not only sheds light on military personnel, but also sheds light on vulnerable populations that are difficult to identify and aid in general healthcare settings.

Staten acknowledged that further research is needed to identify other barriers to treatment in the military. The PrEP prescription could be made more accessible by including more information on sexual histories in the annual physical that active-duty personnel must complete.

“There is no screening for sexual health at least not in the MSM experience,” Staten said. Staten also suggested that additional questions around sexuality should be included in the screening process. This could help encourage more open conversations between health professionals and patients to bridge the gaps in access to care and treatment.

Staten is an active service member. Alves has reported no relevant financial relationships.

ANAC 2021. It was announced on November 11, 2021.

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