Date Published: March 12, 2019
Publisher: Public Library of Science
Author(s): Yusuf Ransome, Meagan Zarwell, William T. Robinson, H. Jonathon Rendina.
Gay, bisexual, and other men who have sex with men (GBM) have the highest proportion of incident HIV infection. Pre-exposure prophylaxis (PrEP) use and screening for sexually transmitted infections (STIs) are primary HIV prevention strategies, however, uptake remains low. Social capital, collective resources generated through social connections, are associated with lower HIV risk and infection. We investigated social capital in association with PrEP indicators among GBM.
Analyses included (N = 376) GBM from the 2014 National HIV Behavioral Surveillance (NHBS) in New Orleans. Multiple regression methods assessed the association between one item within each of eight domains from the Onyx and Bullen Social Capital Scale and: awareness and willingness to use PrEP. Analyses are adjusted for age, race, education, sexual intercourse with women, and health insurance.
Forty percent of GBM were 18–29 years, 52 percent White. Sixty percent were willing to use PrEP. Social capital was above 50 percent across 7 of 8 indicators. Community group participation (vs no participation) was associated with higher likelihoods of PrEP awareness (adjusted Prevalence Ratio [aPR] = 1.41, 95% Confidence Interval [CI] = 1.02, 1.95). None of the seven remaining social capital indicators were significantly associated with any of the PrEP outcomes.
Community groups and organizations could be targeted for interventions to increase uptake of HIV prevention strategies among GBM in New Orleans
Seventy percent of new HIV infections in the United States (US) occur among gay, bisexual, and other men who have sex with men (GBM) . An estimated one in six (16.7 percent) of GBM will become infected with HIV in their lifetime . New HIV diagnosis rates among GBM are highest within the southern states . For instance, the estimated diagnosed HIV prevalence was twice as high in Louisiana compared to the national rate . In New Orleans, Louisiana—the setting of this current study—the primary risk factor for new HIV diagnosis is reported being GBM, which accounted for 56 percent of infections in 2016, among persons who reported a risk factor .
All the study results are reported in Table 1. Approximately 41 percent of GBM sampled were between the ages of 18–29 years, and 52 percent were white. Forty-seven percent were aware of PrEP and 60 percent were willing to use PrEP. Frequency of those reporting yes to seven of the eight social capital indicators was greater than 50 percent. Community group participation was the lowest reported social capital indicator, where 26 percent said yes.
Social capital has been identified as an important social determinant for HIV prevention, especially among GBM globally , yet there is a paucity of work on the topic in the US . Our study contributes to the literature by identifying what specific domains or indicators of social capital may be useful to intervene on among GBM. In our study, although 47 percent of GBM were aware of PrEP, 60 percent of GBM were willing to use PrEP, which is higher than estimates reported among international cohorts conducted around similar times (e.g., 48 percent among GBM in Scotland, UK) . Specific to the US, our estimates are similar to those found in an NHBS sample of GBM from Philadelphia, PA—another urban city . We found that GBM participating in community groups reported significantly higher likelihoods of being aware of PrEP, but the positive association did not reach statistical significance for willingness to use PrEP. These results point to a strong potential for improving uptake of PrEP within the community group settings where diffusion of PrEP awareness could lead to increased willingness and uptake of PrEP may occur among GBM. We expected awareness may be low among participants since PrEP was approved by the FDA less than two years from the time of the study, however we are encouraged by the high willingness to use PrEP.
Despite those limitations, this was the first study to investigate social capital in association with PrEP outcomes in the US  and perhaps globally. The findings contribute to the prevailing theory that social capital can be a protective resource for HIV prevention, with participation in community groups being one mechanism that facilitates the association [36, 64, 65].