Participation in Community Groups Found to Increase Awareness of PrEP

Participation in community groups and organizations, a factor of social capital, was found to increase awareness of pre-exposure prophylaxis (PrEP) to prevent HIV, according to a new study in PLOS One.

Men who are gay or bisexual (GBM) are at the greatest risk of contracting HIV. Research has found that 70% of new HIV infections in the United States occur in this population, and it has been estimated that 16.7%, or 1 in 6 GBM, will become infected with HIV during their lifetime. The study was conducted in Louisiana, where the estimated diagnosed HIV prevalence in the state is twice the national rate.

Participants were 52% white and 41% were between 18 to 29 years old. A total of 376 respondents participated in the study. Individuals who were HIV positive were excluded.

In this study, which was set in New Orleans, researchers found that GBM that participated in community groups were 40% more likely to be aware of PrEP than those who did not.

Data analysis found that 47% of GBM were aware of PrEP. Sixty percent of participants stated that they would be willing to use PrEP, which was higher than reported estimates from global cohorts conducted during the same time period.

In this study, social capital was proposed to be an indicator of awareness of and willingness to use PrEP. Researchers found that social capital was above 50% for 7 out of 8 domains that served as indicators, but none of the 7 remaining social capital indicators was significantly associated with PrEP outcomes.

The study defines social capital as collective resources generated through social connections that facilitate changes in behavior and health. Social capital has been documented to have protective effects on health outcomes, leading to lower HIV-related risk behaviors, lower HIV diagnoses and incidence rates, higher adherence to antiretroviral therapy, and suppressed viral load. Results from the study support the idea that social capital has the potential to be a valuable resource for HIV prevention.

To assess social capital, researchers modified and asked participants a series of questions encompassing 8 domains from the Onyx and Bullen Social Capital Scale. Domains and questions were:

• Value of Life: Do you feel valued by society?
• Work Connections: Are your co-workers or classmates also your friends?
• Tolerance of Diversity: Do you enjoy living among people of different lifestyles?
• Community Group Participation: Are you an active member of a local organization or club?
• Social Agency: If you need information to make a life decision, do you know where to find that information?
• Trust and Safety: Do you feel safe walking down your street after dark?
• Neighborhood Connections: Have you visited a neighbor in the past week?
• Friend Communication: In the past week, how many times did you communicate with friends using your phone?

Responses to all questions were assigned either a value of 1 for a “yes” answer and 0 for “no.” For the “Friend Communication” domain, a value of 1 was assigned only if they spoke to friends more than 40 times per week.

Participants were also asked questions about their awareness of PrEP and whether they were likely to use it. These questions were:

• Before today, have you ever heard of people who do not have HIV taking antiretroviral medicines, to keep from getting HIV?
• Would you be willing to take anti-HIV medicines every day to lower your chances of getting HIV?

The responses were also assigned a value of 1 for a “yes” answer or 0 for “no.”

Multiple regression methods assessed the association between 1 item within each of the domains to determine awareness of and willingness to use PrEP. Analyses were adjusted for race, education level, ever participation of sex with a woman, health insurance access, and age.

Age was found to have no relationship with PrEP awareness. However, researchers found a significant link with being 40 or more years old and willingness to use PrEP. Highest level of education was determined to be strongly associated with PrEP awareness but not enthusiasm to use it. Differences in race had no connection to either PrEP outcome.

The authors said this was the first study to examine social capital in association with PrEP outcomes in the United States, and suggested that targeted interventions with community groups and organizations could be a way to increase use of HIV prevention strategies like PrEP. Considering the study took place in 2014, less than 2 years after the FDA approved PrEP, they suggested a follow-up study to observe changes in both awareness of and willingness to use the drug. Since 2014, PrEP has become more widely accessible, less expensive, and more advertised.

Reference

Ransome Y, Zarwell M, Robinson WT. Participation in community groups increases the likelihood of PrEP awareness: New Orleans NHBS-MSM Cycle, 2014. [published online March 12, 2019]. PLOS One. doi:10.1371/journal.pone.0213022.