Findings from a four-year study of a U.S.
national cohort of 6,059 sexual and gender minority individuals who
have sex with men
NEW YORK, June 26, 2024 /PRNewswire/ -- In a far-reaching
effort to understand the factors contributing to HIV transmission
among sexual and gender minority (SGM) individuals and improve HIV
prevention strategies, a team of scientists at the CUNY Graduate
School of Public Health and Health Policy (CUNY SPH) and the CUNY
Institute for Implementation Science in Population Health (CUNY
ISPH) led a four-year national cohort study of 6,059 cisgender men
and transgender individuals who have sex with men. Key among their
aims was uncovering the reasons why many SGM individuals are not
fully benefitting from highly effective HIV Pre-Exposure
Prophylaxis (PrEP).
PrEP is a powerful means of preventing HIV infection among
groups that experience disproportional HIV burden, with the
capacity to reduce transmission on a massive scale. It's been
available for over a decade, but its uptake among those who could
benefit the most has been slow and inequitable, with significant
racial and ethnic disparities – White SGM individuals have been
adopting PrEP at higher rates than persons of color. Getting on
PrEP is challenging, requiring regular clinical appointments,
bloodwork, and pharmacy coordination. Staying on PrEP can be even
more challenging, requiring continued access to healthcare through,
for example, job stability that provides health insurance, as well
as reliable transportation for PrEP-related appointments.
Socioeconomic factors like housing instability further hinder
consistent use. Substance use, particularly methamphetamine,
amplifies HIV risk and can interfere with PrEP adherence.
The Together 5,000 (T5K) cohort study recruited 6,059 cisgender
men and transgender individuals who have sex with men, aged 16-49,
who were not using PrEP at enrollment but were clinically indicated
for it, and followed them from 2017 - 2022. All were given an HIV
test at study enrollment. Those with negative HIV tests were given
information about PrEP and how it might protect them, and (if
desired) help in beginning the regimen. The study examined
potential factors associated with HIV infection, including
demographic characteristics, socioeconomic status, behaviors, and
PrEP usage. Participants completed annual online surveys and
at-home self-sampling kits for HIV testing over four years.
In this cohort of HIV-vulnerable SGM individuals, the study team
observed high HIV incidence over four years of follow-up (n=303, 5%
of the cohort or 1.64% each year). PrEP use was a major factor in
preventing HIV infection: individuals on PrEP were 80% less likely
to become HIV positive. Notably, starting and then discontinuing
PrEP proved to be a greater risk factor than never having started
it: individuals who had started and then stopped PrEP had the
highest rate of infection in the cohort. Prior studies have
likewise found higher HIV infection risk following gaps in PrEP
use.
Methamphetamine (meth) use in the past year increased risk of
acquiring HIV infection by nearly four-fold. In fact, for every
person who became infected, meth use was reported in the year prior
42% of the time. Findings from this and other studies demonstrate
that meth use is disproportionately impacting SGM individuals from
marginalized racial and ethnic groups, and accounts for one in
three new HIV infections among SGM individuals.
"Our findings point to the urgent need to do more research into
this potentially causal connection and provide more resources to
people who use meth," said CUNY SPH Professor Christian Grov, the
study's lead author.
Race and ethnicity played a role in HIV risk. Non-Hispanic Black
and Hispanic/Latinx participants were significantly more likely to
become infected than non-Hispanic white participants.
"Researchers and policymakers have feared for years that
disproportionate PrEP uptake by race—where white individuals adopt
PrEP at higher rates than other groups—would have the potential to
make existing racial disparities in HIV even worse," said Grov.
"Thus, while our finding is not novel, it underscores the need for
PrEP implementation strategies with more equitable reach that
engage Black and Latinx SGM individuals."
Housing instability increased risk. SGM individuals experiencing
housing instability were at higher risk for both meth use and HIV
infection. Greater education was, predictably, a protective
factor.
"The findings related to meth use are particularly concerning
given that SGM who use meth are increasingly injecting it, raising
the possibility of increased infection risk through needle sharing
in addition to any of the stimulant's effects on sexual behavior,"
said CUNY SPH Distinguished Professor Denis
Nash, a co-author on the study.
The study highlights the critical need for interventions to
improve PrEP uptake and retention among sexual and gender minority
individuals, particularly Black/Latinx individuals, those with
housing instability, lower education levels, and people who use
methamphetamine. Enhanced PrEP implementation strategies and
addressing structural barriers are essential for reducing HIV
incidence in these vulnerable populations. Equally important are
interventions to support the long-term maintenance of individuals
currently on PrEP and to re-engage those who may fall out of care,
given the exceptionally high risk of infection in these groups.
This study, led by CUNY SPH and CUNY ISPH, is the product of a
broad collaboration with investigators from Florida International University, University of Massachusetts Boston, University of Florida, University of Memphis, Albert Einstein College of Medicine,
Hunter College, SUNY Downstate, and
Rutgers University.
Media contact:
Ariana Costakes
ariana.costakes@sph.cuny.edu
About CUNY SPH
The CUNY Graduate School of Public
Health and Health Policy (CUNY SPH) is committed to promoting and
sustaining healthier populations in New
York City and around the world through excellence in
education, research and service in public health and by advocating
for sound policy and practice to advance social justice and improve
health outcomes for all. sph.cuny.edu
About CUNY ISPH
The CUNY Institute for Implementation Science in Population
Health (ISPH) was founded on the notion that substantial
improvements in population health can be efficiently achieved
through better implementation of existing strategies, policies, and
interventions across multiple sectors. We study how to translate
and scale-up evidence-based interventions and policies within
clinical and community settings in order to improve population
health and reduce health disparities. CUNY ISPH. Pursing population
health gains through better implementation. www.cunyisph.org.
Follow us on Twitter: @CUNYISPH.
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SOURCE CUNY SPH