4320.0 - Geospatial and Social-Structural Determinants of PrEP Use among Black, Latinx, and Multiracial Sexual and Gender Minorities who have Sex with Men in the United States
Session: Ending the HIV Epidemic
Author: Yusuf Ransome
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Abstract
Background
Despite advances in HIV prevention and treatment, Black, Latino/a/e/x, and Multiracial (BLM) sexual and gender minorities who have sex with men (SGMSM) in the US continue to experience the highest HIV burden. We investigate how the spatial and geographic distribution of social-structural factors drives systemic barriers to HIV prevention.
Methods: Data were from a national cohort of 5,144 BLM SGMSM nested within 3,119 zip codes recruited across all 50 states, Washington D.C., and Puerto Rico primarily through digital platforms. We examined geospatial patterns in the distribution of PrEP providers by mapping participant location relative to the nearest PrEP provider. We used multilevel analysis and other spatial methods to examine county- and state-level indicators of HIV, structural racism, poverty, and drive time to nearest PrEP provider as predictors of PrEP use.
Results
Preliminary findings reveal spatial clustering of participants across US cities. Drive time to the nearest PrEP provider, structural racism, local HIV, and poverty were associated with PrEP use. Specifically, mean drive time was lower among those who ever used PrEP (32.8 minutes) compared to those who never used PrEP (40.3 minutes). Compared to people living in a zip code with less than 10 minutes drive time to a PrEP provider, those who travel over 60 mins have 29% lower odds of ever using PrEP (OR=0.71, p=0.001). After adjusting for social-structural factors, the association between drive time over 60 min and ever PrEP use was attenuated, while living in an EHE jurisdiction was associated with 16% higher odds of PrEP use (OR=0.84, p=0.046).
Conclusions
Our analyses reveal that PrEP access appears to be geospatially patterned and socially determined across the U.S. Access to this structural level resource was associated with an individual’s likelihood of using PrEP, above and beyond their individual compositional characteristics such as age, insurance, education and income. Our findings demonstrate how place-based and other social determinants can be assessed to identify priority areas where enhanced HIV prevention resources are needed, particularly in locations where multiple structural barriers intersect. Findings provide evidence-based guidance for targeting resources toward identified high-need areas and implement tailored place-based HIV prevention programs.