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Publication Profiles

Brief Report: Associations Between Self-Reported Substance Use Behaviors and PrEP Acceptance and Adherence Among Black MSM in the HPTN 073 Study

Citation

Okafor CN, Hucks-Ortiz C, Hightow-Weidman LB, et al. Brief Report: Associations Between Self-Reported Substance Use Behaviors and PrEP Acceptance and Adherence Among Black MSM in the HPTN 073 Study. J Acquir Immune Defic Syndr. 2020;85(1):23-29. doi:10.1097/QAI.0000000000002407

Implementation stage:

Sustainment

Implementation outcomes reported:

Adoption

Continuum target addressed:

PrEP initiation, PrEP adherence

Geography:

Non-priority jurisdiction

Study Participant Classification:

Recipients of care

Plain Language Objectives

The researchers wanted to learn whether alcohol or drug use was related to starting HIV-prevention medicine or taking it consistently among Black men who have sex with men. Medication-taking was checked with drug-level blood tests.

Plain Language Abstract

Black men who have sex with men experience a disproportionate share of new HIV diagnoses, and substance use may create concerns about consistent use of pre-exposure prophylaxis, or PrEP. The researchers analyzed longitudinal data from 226 HIV-negative Black men in HPTN 073. Participants repeatedly reported alcohol, marijuana, popper, and stimulant use, including use before or during condomless anal sex. PrEP initiation and medication-taking were assessed, with adherence measured through drug levels in blood. Most substance-use behaviors were not significantly associated with starting PrEP or taking it consistently. One exception was stimulant use before or during condomless anal sex, which was associated with substantially lower odds of adherence (adjusted odds ratio 0.21). The findings suggest that PrEP adherence was achievable for many participants who used substances, while those using stimulants in sexual contexts may need additional behavioral-health or medication support. Substance use was self-reported, and the observational analysis identifies an association rather than proving that stimulant use caused lower adherence. The results apply most directly to Black men participating in this specific prevention study.

Key Takeaways

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