Pre-Exposure Prophylaxis and Openness with Healthcare Providers Among Military Men Who Have Sex with Men

Abstract

Background: Pre-Exposure Prophylaxis (PrEP) significantly lowers HIV transmission; however, uptake remains low. One in five military members are at high risk for HIV, and men who have sex with men (MSM) are disproportionately vulnerable to infection yet are among the least likely to be prescribed PrEP. Understanding patient and provider relationships among these populations is crucial to improving PrEP uptake and decreasing disease burden. Method: A 41-item survey was disseminated to active duty MSM (n=354). A multivariable linear regression explored the effects of perception of equitable and culturally competent care from the Veterans Affairs health system, willingness to take PrEP, and race/ethnicity on the degree of sexual orientation disclosure with providers. Results: Most identified as Caucasian (37.6%), followed by 25.4% identifying as Black, and 20.3% identifying as Latinx. A majority identified as gay (69.5%), with 23.4% and 7.1% who identified as bisexual and straight, respectively. Perception of equitable care was related to increased sexual orientation disclosure (p=.03). Increased willingness to accept PrEP was related to increased sexual orientation disclosure (p=.001). Identifying as Black (p<.001) and Latinx (p<.001) was associated with increased sexual orientation disclosure, whereas identifying as Asian was associated with a lower degree of sexual orientation disclosure (p=.006). Conclusions: Active duty MSM who were more amenable to PrEP and those who perceived their provider as culturally competent demonstrated a higher degree of openness regarding their sexual orientation. Furthermore, active duty MSM who identified as Asian were less open.