BLOOMINGTON, IN — Even though about 20.9% of U.S. servicemembers report a high risk of HIV infection, only about 2,000 of them had accessed HIV pre-exposure prophylaxis (PrEP), as of 2017.
A study from Indiana University in Bloomington and Walter Reed National Military Medical Center in Bethesda, MD, used a cross-sectional design to explore PrEP prescription predictors among 354 servicemembers who identify as a man who has sex with other men (MSM).
The analysis in the American Journal of Men’s Health took into account four predictor variables:
- partner HIV status,
- race/ethnicity,
- primary partner gender, and
- sexual orientation on the odds participants’ report being prescribed PrEP.1
Most of the participants, 69.5%, identified as gay, while 23.4% identified as bisexual. Results indicated that bisexual participants were 2.1 times (p = <0.04) less likely to be prescribed PrEP.
“Accordingly, those who identify their primary sex partner as female were 5.1 times less likely to be prescribed PrEP (p < 0.001),” according to researchers. “MSM servicemembers who had a partner disclose their HIV-positive status were 4.1 times more likely to have been prescribed PrEP (p = 0.013). Finally, participants who identify as Black were three times more likely (p = 0.001), and Latinx MSM were 3.6 times more likely (p = 0.003) to have been prescribed PrEP.”
Background information in the article noted that the incidence of HIV in the United States declined by 9% from 2015 through 2019, credited to pharmaceutical advancements, including pre-exposure prophylaxis.
“PrEP is a form of HIV prevention that includes sex risk reduction education and a once-daily pill that, when taken as directed, has been proven to reduce the chance of acquiring HIV by more than 90%,” the authors pointed out, adding that not all groups demonstrate an equitable decline in diagnoses.
“In the United States, men who have sex with other men (MSM) bear a disproportionate disease burden of HIV, accounting for 58% of new diagnoses,” the researchers added. “In accordance with national trends, active-duty MSM comprise the vast majority of HIV infections among military personnel. The percentage of new HIV infections that occur among active-duty MSM has remained consistent over the past few years.”
The study advised that finding military personnel who are eligible for PrEP has been difficult. One reason is that the number of MSM active-duty servicemembers is less than that of the general population, with 1.9% of males identifying as gay and 2% identifying as bisexual. Still, 2.2% of active-duty men surveyed reported that they were mostly or only attracted to men, followed by 1.2% who stated they were equally attracted to men and women and 4.3% describing themselves as being mostly attracted to women. The large majority, 90.1%, said attracted to women exclusively. Despite that, the study noted that 3.3% of male servicemembers surveyed reported a sexual encounter with another man in the previous 12 months.
The U.S. military offers free medical care for HIV and PrEP, and all military personnel are required to be screened for HIV every two years. There has not been a standard method for identifying those servicemembers who are at a more significant risk of acquiring HIV and, thus, require more frequent testing, however, the researchers advised.
In 2016, when about 2,000 servicemembers and their dependents had been prescribed PrEP, about 12,000 were considered suitable candidates, the study noted. “The large number of people who could prevent HIV with PrEP but are not taking it suggests that the current system for identifying those at risk is not working,” the authors suggested. “And a recent systematic review of HIV prevention among U.S. military service members reported that while some research exists, more is needed to understand how best to prevent HIV acquisition among this population.”
- Carter G, Staten IC, Woodward B, Mahnke B, Campbell J. PrEP Prescription Among MSM U.S. Military Service Members: Race and Sexual Identification Matter. Am J Mens Health. 2022 Nov-Dec;16(6):15579883221133891. doi: 10.1177/15579883221133891. PMID: 36317720; PMCID: PMC9630896.
