Drug Use but Not Race Affect PEP Use in High-Risk Los Angeles Group

Drugs and PEP

Illicit drug use and gonorrhea raised chances that people using a Los Angeles healthcare center would ask for postexposure prophylaxis (PEP). Race did not affect chances of PEP use, though African Americans represented a disproportionate number who tested positive for HIV.

Nonoccupational PEP is an established HIV prevention tool among people who have frequent high-risk sex with HIV-positive people or people of unknown HIV status. Although men who have sex with men (MSM) in Los Angeles County use PEP frequently, factors favoring PEP use were unclear until this study.

Researchers collected data on all clients enrolled in the Los Angeles LGBT Center between May 2011 and December 2012 and on people who visited the center for sexually transmitted infection (STI) screening. Multivariate logistic regression analysis identified three factors that raised the odds of PEP use compared with high-risk non-PEP clients, at the following odds ratios (OR) and 95% confidence intervals (CI):

• Gonorrhea in past 12 months: OR 1.71, 95% CI 1.25 to 2.35
• Methamphetamine use in past 12 months: OR 1.71, 95% CI 1.30 to 2.24
• Inhaled nitrate use in past 12 months: OR 1.62, 95% CI 1.30 to 2.01

Methamphetamine use in the past 12 months almost tripled chances that a person would use PEP more than once (OR 2.80, 95% CI 1.65 to 4.75).

PEP clients did not differ from high-risk non-PEP clients by race or ethnicity in the entire cohort or among MSM. However, African Americans made up 8.5% of people using PEP but 16.7% of those who tested positive for HIV.

"Similar proportions of PEP use by race/ethnicity are problematic," the researchers observe, "considering the disproportionate burden of HIV infections in the African American community."

"Although [PEP] uptake among the highest risk populations has been brisk," the authors conclude, "inequities based upon race/ethnicity suggest the need for increased outreach."

Source: Matthew R. Beymer, Robert K. Bolan, Risa P. Flynn, Dustin R. Kerrone, David L. Pieribone Sonali P. , Kulkarni, Jackelyn C. Stitt, Everardo Mejia, Raphael J. Landovitz. Uptake and repeat use of postexposure prophylaxis in a community-based clinic in Los Angeles, California. AIDS Research and Human Retroviruses. 2014; 30: 848-855.

Written by Mark Mascolini on behalf of the International AIDS Society