Among active-duty men who have sex with men (MSM), Black and Latino military members are at least three times as likely to be prescribed HIV pre-exposure prophylaxis (PrEP) than their White counterparts, according to new survey results.
“In the civilian population, triphala que es we see a lot of challenges and barriers to [accessing PrEP] in our high-risk populations — populations in the MSM sphere that are people of color,” study author Colten Staten, RN, a first lieutenant in the army at Walter Reed National Military Medical Center in Bethesda, Maryland, told Medscape Medical News. Because all active-duty service members have free medical care and prescriptions through the Military Health System, the findings demonstrate “what happens when access becomes less of an issue in regard to receiving PrEP prescriptions,” he noted.
The survey, which was presented November 11 at the Association of Nurses in AIDS Care 2021 conference, was available for 5 days in 2020. All participants were at least 18 years old, identified as MSM, and were active-duty members of the United States military.
Of the 354 men included in the study, 37.6% were White, 25.4% were Black, 20.3% were identified as Latino, 6.5% were Asian/Pacific Islanders, and 5.6% were Native Americans. In addition, 69.5% identified as gay, 23.4% identified as bisexual, and 7% said they were straight. And 17.2% had a partner who disclosed he was HIV positive, but 19.2% did not know the status of their partner.
Black participants were three times more likely to have been prescribed PrEP than White service members (P < .001). Similarly, Latino respondents were 3.6 times more likely to be prescribed PrEP than their White counterparts (P = .003). Participants whose partner disclosed an HIV-positive status were 7.1 times more likely to receive a PrEP prescription than someone who did not know the status of their partner (P = .013), and bisexual respondents were 2.1 times less likely to have received a PrEP prescription than respondents who identified as gay (P = .04).
While the study demonstrates that at-risk populations are receiving PrEP in the military, research suggests that PrEP is still underprescribed in this population, Staten said. A 2018 study published in Morbidity and Mortality Weekly Report found that 20.9% of US service members reported a high risk of HIV infection, and an estimated 12,000 individuals in the military qualify for a PrEP prescription. Yet, from February 1, 2014, to June 10, 2016, only 759 service members were prescribed Truvada. The 2018 report found that approximately 350 active-duty service members are diagnosed with HIV every year, with a disproportionate number of new infections occurring in Black individuals.
While the study suggests prescriptions are reaching target populations, “the most concerning finding is that it is not happening in the robust nature that we need,” said Justin Alves, RN, ACRN, CARN, a nurse at Boston Medical Center in Massachusetts who was not involved with the study, in an interview with Medscape Medical News. “This is the start of a lot of research that needs to happen, because not only does the study shed light on people who are serving in the military, but it also sheds light on unique vulnerable populations that we have a hard time capturing and helping in general healthcare settings,” Alves said.
Staten agreed that more research is needed to identify additional barriers to care in the military. Additionally, including more information on sexual history in the yearly physical all active-duty service members complete could also help identify more individuals who would benefit from a PrEP prescription.
“There is no screening for sexual health, as far as the MSM experience,” Staten said. And he suggested that more questions around sexuality should be included in the screening process. That could help spur more open conversations between patients and providers to bridge gaps in access and care.
Staten is an active-duty service member. Alves has reported no relevant financial relationships.
ANAC 2021. Presented November 11, 2021.
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