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Objective: The objective of this study is to use GPS technology to determine if violent and property crime exposure to participants activity spaces affect outcomes of the HIV prevention and care continuum (PCC) among Young black sexually minoritized men (YBSMM) and transgender women (TGW), a subgroup at high vulnerability for new HIV diagnoses. Exposure to violent and property crime adversely affects a variety of acute and chronic medical conditions; however, the relationship between exposure to violent and property crime and HIV risk [e.g. preexposure prophylaxis (PrEP) nonuse] is unknown. Spatial analytic analysis using dynamic Global Position Systems (GPS) technology can accurately detect geospatial associations between the crime exposure and objective HIV-related outcomes., Methods: With the Neighborhoods and Networks (N2) Cohort Study, GPS technology to identify the activity space of 286 [123 people with HIV (PWH) and 163 people without HIV (PWoH)] YBSMM and TGW living in Chicago, Illinois, to identified spatial associations between violent and property crime exposures with HIV PCC outcomes., Results: We found that YBSMM and TGW with higher exposure areas with higher levels of violent crime were less likely to use HIV PrEP therapy [adjusted odds ratio (aOR) 0.76, 95% confidence interval (CI) 0.63-0.91, P  = 0.03]., Conclusion: This study demonstrates the importance of clinical providers to consider violent crime as a potential sociostructural barrier that may impact medication adherence and healthcare outcomes among vulnerable populations. Additionally, GPS technology offers an alternative data analytic process that may be used in future studies to assist in identifying barriers to ending the HIV epidemic., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Black sexual minority men (SMM) in the Deep South are heavily impacted by HIV; yet studies fail to consider discordance across aspects of sexual orientation (i.e., identity, attraction, behavior) or how a lack of concordance enhances vulnerability to HIV. We sought to explore the overlap across aspects of sexual orientation and examine associations between each aspect and the number of sexual partners who engaged in HIV vulnerability-enhancing behaviors, and HIV prevention and care outcomes. A total of 204 Black SMM completed surveys, reporting their sexual identity, attraction, and behavior (i.e., sex with men only vs. sex with men and women), number of condomless sex or transactional sex (e.g., buyers vs. sellers) partners in the past 6 months, and adherence to pre-exposure prophylaxis (PrEP) or antiretroviral therapy (ART) among users. Less than one in four participants (22.5%) reported overlap in same-sex sexual orientations, while 17.1% of bisexual men reported overlap across aspects. In multivariable models, differences were found in how aspects of sexual orientation were associated with the number of partners who bought or sold sex; as well as how often participants tested for HIV in the past 12 months. Results suggest different aspects of sexual orientation have implications for addressing HIV among Black SMM in the Deep South., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We sought to describe and quantify the association between HIV service organization availability, HIV burden, and HIV awareness and prevention in the 57 priority jurisdictions selected as part of the U.S. Ending the HIV Epidemic initiative. On average, jurisdictions with more per capita organizations had more people living with HIV, more individuals aware of their positive status, and more individuals prescribed PrEP (b = 0.3; 95% CI [0.2, 0.5] for each additional case per 1,000 people in the first metric, and b = 0.3; 95% CI [0.2, 0.4] and b = 0.1; 95% CI [< 0.1, 0.1], respectively, for each percentage point change in the second two metrics), accounting for jurisdiction size. Several jurisdictions were outliers in the modeled associations and may reflect comparatively better, or worse, performance than similar jurisdictions. This information can assist in evaluating resource allocation and determining whether availability translates to accessibility.

PrEP uptake and adherence among young Black sexual minority men (YBSMM), has been sub-optimal. Multiple studies identified sleep as an important determinant of medication adherence, although it has not been examined with regard to PrEP among YBSMM. This study utilized data collected from HIV-negative cisgender YBSMM in the Neighborhoods and Networks (N2) study in Chicago using PrEP (N = 70). Sleep quality was measured using the PHQ-9 and PrEP adherence questions were adapted from Reynolds et al., 2004. Bivariate and multivariable regression analyses were used to estimate associations between sleep and missing PrEP doses, controlling for relevant demographic and behavioral factors. YBSMM who reported sleep disturbance a moderate amount of time (aOR 7.59 [1.05 to 54.57]) were more likely to miss taking PrEP because they had too many pills to take. Sleep quality is an overlooked determinant of medication adherence, and may negatively impact YBSMM's ability to consistently take PrEP., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We examined associations between COVID-19 conspiracy beliefs and HIV status neutral care engagement among Black cisgender sexual minority men (BCSMM) and Black transgender women (BTW). Throughout April-July 2020, a total of 226 (222 in the current analysis: 196 BCSMM, 20 BTW, and 6 other) participants in Chicago's Neighborhoods and Networks (N2) cohort study completed virtual assessments. Participants reported their HIV status, changes in the frequency of PrEP/ART use, and COVID-19 conspiracy beliefs. Three-quarters of the sample believed at least one conspiracy theory that COVID-19 was either government-created or lab-created accidentally or purposefully. Believing one or more COVID-19 conspiracy theories was significantly associated with better PrEP or ART engagement (using PrEP more frequently or continuously using PrEP/Missing ART less or continuously using ART) (aPR = 0.75 [95% CI 0.56-0.99], p < 0.05). Believing COVID-19 came about naturally was strongly associated with worse PrEP engagement (i.e., use PrEP less or not on PrEP) or worse ART engagement (i.e., missed ART more or not on ART) (aPR = 1.56 [95% CI 1.23, 1.98], p < 0.001). Findings suggested substantial COVID-19 conspiracies among BCSMM and BTW, and this was associated with HIV care engagement., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017-January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) individual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies., (© 2021. The Author(s).)

This study investigated sexual identity and behavior and their potential associations with PrEP use and attitudes in cisgender Black gay and bisexual men. A total of N = 173 (mean age 25.2) participants from the Neighborhoods and Networks (N2) Study in Chicago were included. Of these, 104 were gay-identified and reported sex with men only (GSMO), 26 were gay-identified and reported sex with men and women (GSMW), 8 were bisexual-identified and reported sex with men only (BSMO), and 35 were bisexual-identified and reported sex with men and women (BSMW). Reporting sex with men and women in the past 6 months, RR = 0.39, 95% CI [0.17, 0.89], identifying as bisexual, RR = 0.52, 95% CI [0.29, 0.92], and the combination of the two, RR = 0.24, 95% CI [0.07, 0.76] were significantly associated with lower rates of current oral PrEP use. Black bisexual-identifying men who reported sex with men and women were significantly more likely to have discontinued oral PrEP, RR = 2.50, 95% CI [1.14, 5.50], than Black gay-identified men who reported sex with men only. Participants who had not used oral PrEP before reported lower levels of interest in long-acting injectable PrEP than those who were currently using oral PrEP, RR = 0.56, 95% CI [0.40, 0.79]. No other significant differences were found. Overlooking the combination of sexual identity and behavior may mischaracterize PrEP rates and miss uniquely vulnerable subgroups. Black gay and bisexual men who had not used oral PrEP may be particularly disinterested in long-acting injectable PrEP., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Young black men who have sex with men (YBMSM) and young black transgender women (TGW) have experienced a stark disparity in HIV prevention and care. Resilience, collective resources to adapt stressors or adversities, may improve HIV prevention and care outcomes. The present study investigated the association of resilience-based factors with PrEP uptake and viral suppression from a socioecological perspective among YBMSM and young black TGW. Data were from the baseline cycle of the Neighborhoods and Networks (N2) Study, an ongoing cohort study of 16-34-year-old YBMSM and young black TGW in Chicago (n = 324). Confidant network-level and neighborhood affiliation variables were created to measure the social-environmental context of resilience. All analyses were stratified by participants' HIV status (184 HIV-negative participants and 140 HIV-positive participants). Among HIV-negative participants, having a parental figure within an individual's confidant network was significantly associated with a greater likelihood of PrEP use. Among HIV-positive participants, confidant network members' awareness of an individual's HIV status was associated with viral suppression. Social support resources from confidant networks could improve HIV prevention and care engagement among YBMSM and young black TGW. Understanding the social and environmental contexts of resilience resource is critical for HIV prevention and care engagement.

Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.

Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34-2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07-1.50, aRR 1.32; 95% CI 1.13-1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21-4.16, aRRR 2.58; 95% CI 1.09-6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03-0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions.

Pre-exposure prophylaxis (PrEP) is an important biomedical human immunodeficiency virus (HIV) prevention tool gaining more popularity among Parisian men who have sex with men (MSM) who engage in transactional sex. This study examines the knowledge of, and willingness to use, different modalities of PrEP among this subgroup. Broadcast advertisements were placed on a geosocial-networking smartphone application with a link to a Web-based survey during three 24-hour periods in October 2016. Modified Poisson regression models were used to assess the association between engagement in transactional sex and preferences for each of these PrEP modalities. A total of 444 respondents were included. About 14% reported engagement in transactional sex. In all, 90% of MSM who engaged in transactional sex were knowledgeable of daily oral PrEP, while 13.3% were knowledgeable about long-acting injectable PrEP or penile or rectal microbicides. They were more likely to be aware of long-acting injectable PrEP (aRR = 2.52, 95% CI = 1.16 to 5.47) and willing to use daily oral PrEP (aRR = 1.48; 95% CI = 1.11 to 1.98) or long-acting injectable PrEP (aRR = 1.40; 95% CI = 1.09 to 1.81) than MSM who had not engaged in transactional sex. Long-acting injectable PrEP may be an important HIV-prevention option for MSM who engage in transactional sex if this modality is proven effective.

Sex tourism among men who have sex with men (MSM) has been associated with increased risk for human immunodeficiency virus (HIV) due to sexually scripted environments characterized by multiple sexual partners, increased availability of alcohol and drugs, and limited availability of HIV-prevention services. The current study examined the knowledge of and likelihood of using different modalities of pre-exposure prophylaxis (PrEP), an important biomedical HIV-prevention strategy, among MSM in Paris who have engaged in sex tourism. A sample of 580 MSM from a highly popular geosocial-networking smartphone application in Paris, France, participated in the survey. Of the 580 MSM, 444 participants reported an HIV-negative status and represent the analytic sample for this study. Approximately 27% reported engaging in sexual tourism. MSM who engaged in sex tourism were more likely to aware of on-demand PrEP and more likely to express interest in using on-demand PrEP (adjusted risk ratio [aRR] = 1.26; 95% confidence interval [CI] = 1.03-1.53, aRR = 1.29; 95% CI = 1.04-1.61, respectively) than MSM who never engaged in sex tourism. Moreover, participants who engaged in sex tourism were more likely to express interest in rectal microbicides or both rectal and penile microbicides (aRR = 1.34; 95% CI = 1.13-1.59, aRR = 1.26; 95% CI = 1.03-1.55, respectively) than participants who had not engaged in sex tourism. With the high likelihood of interest in using alternative forms of PrEP in MSM who engage in sex tourism, this study suggests potential benefits for these alternative forms of PrEP for this specific population and underscores the importance of their continued development.

Objective: Young black men who have sex with men (YBMSM) in the USA represent a subgroup that has the highest HIV incidence among the overall population. In the USA, pre-exposure prophylaxis (PrEP) is an effective prevention intervention to prevent HIV acquisition when taken regularly. Neighbourhood and network factors may relate to PrEP awareness, but have not been studied in YBMSM. This study aimed to examine the relationship of neighbourhood and network characteristics with PrEP awareness among YBMSM., Methods: We used data collected from a sample of 618 YBMSM in Chicago (2013-2014). Home addresses were collected for participants and enumerated network members. Administrative data (eg, 2014 American Community Survey, Chicago Department of Public Health) were used to describe residence characteristics. Network member characteristics were also collected (eg, sexual partners' sex-drug use, confidant network members who were also MSM). Multilevel analysis was performed to examine the relationships of neighbourhood and network characteristics to PrEP awareness., Results: Higher neighbourhood-level educational attainment (adjusted odds ratio (aOR) 1.02, p=0.03) and greater primary care density (aOR 1.38, p=0.01) were associated with greater PrEP awareness; greater neighbourhood alcohol outlet density (aOR 0.52, p=0.004) was associated with less PrEP awareness. Sexual network members residing in the same neighbourhood as the participants (aOR 2.58, p=0.03) and discussions around avoiding HIV acquisition with confidants (aOR 2.26, p=0.04) were associated with greater PrEP awareness., Conclusions: The results suggest that neighbourhood and network characteristics can influence PrEP awareness in YBMSM. Additional studies are needed to understand the influences of neighbourhood (eg, MSM serving venues) and network (eg, peer to peer communication) characteristics on dissemination of PrEP information, uptake and adherence and the related mechanisms behind the associations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

As a prevention strategy, HIV pre-exposure prophylaxis (PrEP) may benefit men who participate in group sex, but little is known about PrEP among this group internationally and virtually nothing is known of the European context. This study used an online survey of gay men living in Paris, France to assess associations between group sex and awareness of, use and interest in PrEP in its once-daily, episodic, injectable, and microbicidal forms. Men reporting recent (within 3 months) condomless group sex were much more likely to report once-daily PrEP use than men with no group sex experience (41.5% vs 7.7%, p < .001). Uptake was similarly low among men who had group sex with condoms (8.0%) and those with less-recent experience (6.43%). Overall, willingness to use PrEP-including its non-daily forms-was high among men reporting group sex, suggesting opportunities for outreach and implementation.

Men who have sex with men (MSM) who use smartphone applications (apps) to meet sexual partners represent a high-risk subset of MSM. As such, the use of pre-exposure prophylaxis (PrEP) may be highly suitable. The purpose of the study was to evaluate awareness of and willingness to use PrEP among 179 HIV-uninfected MSM recruited in London who use these apps. Regression models were fit to assess the associations between perceived barriers and willingness to use PrEP in the future. Most (84.9%) had heard of PrEP and more than half (57.1%) were willing to use PrEP in the future if it were to become available. Low perceived risk for acquiring HIV (prevalence ratio (PR): 0.11; 95% confidence interval (CI): 0.04, 0.33) and concerns about PrEP-related side effects (PR: 0.01; 95% CI: 0.00, 0.04) were associated with being unwilling to use PrEP. Efforts to make PrEP widely available should be continued. Uptake interventions should focus on correcting self-perceptions of HIV risk and educate MSM about the potential side effects of PrEP use so that MSM can make more informed decisions about prevention options.

Men who have sex with men (MSM) commonly use inhaled nitrites, or poppers, though their use is a risk factor HIV seroconversion. Pre-exposure prophylaxis, or PrEP, is effective for HIV prevention, but is not widely used, and little is known regarding PrEP use and acceptability among MSM who use inhaled nitrites. We surveyed 580 MSM in Paris, France in 2016 about popper use, sexual behaviors including condomless anal intercourse (CAI), serosorting, and sexual positioning, PrEP use, PrEP candidacy, and interest in alternate PrEP delivery modalities. We included 444 HIV negative participants for the current study. 46.2% reported popper use in the prior 3 months. Using multivariate adjusted logistic regression, we found that popper users were more likely than non-users to consider themselves candidates for PrEP [adjusted relative risk ratio (aRRR) = 2.73; 95% CI 1.54-4.83], but they were not more likely to be current (aRRR = 1.54; 95% CI 0.71-3.33) or past (aRRR = 1.37; 95% CI 0.44-4.28) PrEP users. Mediation analyses indicated that increased CAI and serosorting partly explained the relationship between popper use and PrEP candidacy. There was considerable interest in alternate proposed PrEP delivery modalities, particularly long-acting injectable PrEP [adjusted risk ratio (aRR) = 1.43; 95% CI 1.15-1.79].

The current study sought to examine awareness of, willingness to use, and preferences for available and theoretical administration modalities for HIV pre-exposure prophylaxis (PrEP) and the association of anal sex roles with these concepts among a sample of men who have sex with men (MSM) in Paris, France. Broadcast advertisements were placed on a popular geosocial-networking smartphone application for MSM to direct users to complete a Web-based survey. MSM answered questions on their recent engagement in condomless anal intercourse and awareness of and willingness to use PrEP in the form of once daily and event-driven pill regimens, long-acting injections, and penile and rectal microbicides as well as sexual roles. Multinomial regression models were fit to assess the association between behaviorally classified anal sexual role and preferences for one of these biomedical prevention modalities. A total of 482 HIV-uninfected MSM completed the survey, 48.1% of whom engaged in some form of condomless anal intercourse in the preceding 3 months. Most respondents (85.3%) had heard of once daily PrEP, but fewer respondents had heard of other prevention strategies. Assuming equal effectiveness, long-acting injections were the most commonly preferred (21.8%). Behaviorally defined "bottom" and "versatile" MSM more frequently preferred long-acting injections (32.9% of "bottoms" and 25.3% of "versatiles"). The development of long-acting injections to deliver antiretroviral drugs and topical microbicides may offer more convenient and acceptable options for HIV prevention among MSM, as MSM in this sample were willing to use them and would prefer to use them over currently available pill regimens.

Geosocial-networking smartphone applications are commonly used by gay, bisexual, and other men who have sex with men (MSM) to meet sexual partners. The purpose of the current study was to evaluate awareness of and willingness to use pre-exposure prophylaxis (PrEP) among MSM who use geosocial-networking smartphone applications residing in New York City. Recruitment utilizing broadcast advertisements on a popular smartphone application for MSM yielded a sample of 152 HIV-uninfected MSM. Multivariable models were used to assess demographic and behavioral correlates of awareness of and willingness to use PrEP. Most participants (85.5 %) had heard about PrEP but few (9.2 %) reported current use. Unwillingness to use PrEP was associated with concerns about side effects (PR = 0.303; 95 % CI 0.130, 0.708; p = 0.006). Given that more than half (57.6 %) of participants were willing to use PrEP, future research is needed to elucidate both individual and structural barriers to PrEP use among MSM.

Geosocial-networking smartphone applications such as Grindr can help men who have sex with men (MSM) meet sexual partners. Given the high incidence of HIV in the Deep South, the purpose of our study was to assess HIV risk and preexposure prophylaxis (PrEP) awareness and use in a sample of HIV-uninfected, Grindr-using MSM residing in Atlanta, Georgia (n = 84). Most (n = 71; 84.6%) reported being somewhat or very concerned about becoming HIV infected. Most (n = 74; 88.1%) had been tested for HIV in their lifetimes. About three fourths (n = 65; 77.4%) were aware of PrEP, but only 11.9% currently used the medication. HIV continues to disproportionately impact MSM and represents a significant source of concern. As the number of new infections continues to rise, it is important to decrease risks associated with acquisition and transmission of HIV by increasing rates of HIV testing and the use of biobehavioral interventions such as PrEP., (Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

In France, men who have sex with men (MSM) experience the highest HIV incidence. MSM who use multiple venues such as bars and smartphone apps to find sexual partners have greater HIV and sexually transmitted infection risk than those who use a single physical or online venue. To explore the role of venues and sexual behavior on HIV risk, we used latent class analysis to highlight underlying profiles of 580 MSM in Paris, France. Three latent classes emerged: Multi-venue Users (19%), Non-serosorting App Users (49%), and Serosorting App Users (32%). Multi-venue Users had the highest probabilities of condomless receptive anal intercourse (CRAI) and condomless insertive anal intercourse (CIAI), group sex, and meeting partners at venues such as bars or online. Non-serosorting App Users had the lowest probabilities of CRAI, CIAI, and condomless serosorting. Serosorting App Users had an 87% chance of condomless serosorting. MSM reporting a pre-exposure prophylaxis history had 14 and 5 times the odds of being classified as Multi-venue Users and Serosorting App Users than Non-serosorting App Users. MSM were 3% more likely to be Multi-venue Users than Non-serosorting App Users for every one-year increase in age. Interventions addressing sexual risk behaviors among MSM in France should consider tailored risk-reduction and prevention messaging. [ABSTRACT FROM AUTHOR]

Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34–2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07–1.50, aRR 1.32; 95% CI 1.13–1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21–4.16, aRRR 2.58; 95% CI 1.09–6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03–0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions. [ABSTRACT FROM AUTHOR]

We examine how various pre-exposure prophylaxis (PrEP) accessibility measures impact the detection of PrEP shortage areas and the relation of shortage areas to social determinants of health (SDOH). Using ZIP Code Tabulation Areas (ZCTAs) in New York City as a case study, we compared 25 measures of spatial PrEP accessibility across four categories, including density, proximity, two-step floating catchment area (2SFCA), and Gaussian 2SFCA (G2SFCA). Bayesian spatial regression models were used to examine how PrEP accessibility is associated with SDOH. Using density to measure PrEP accessibility for small areas such as ZCTAs poses challenges to statistical modeling because the measured accessibility values are highly skewed with excess zeros, leading to the necessity of using complex models such as the two-part mixture model. When G2SFCA measures are used, which account for distance decay effects and the competition from the PrEP demand side, findings on PrEP shortage area detection and the association between PrEP accessibility and SDOH were more consistent and less sensitive to spatial scales (i.e., varying from 10- to 30-minute driving). This research adds to the nascent research on PrEP accessibility measurement and sheds light on selecting an appropriate measure to assess spatial disparities in PrEP accessibility and its associations with SDOH. [ABSTRACT FROM AUTHOR]