Sexual violence, PrEP discussion, and PrEP use among HIV-negative men who have sex with men in 23 U.S. urban areas – National HIV Behavioral Surveillance, 2017

Background Men who have sex with men (MSM) who experience sexual violence are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection. Associations between sexual violence and PrEP discussion or PrEP use among MSM are not well-understood. Methods National HIV Behavioral Surveillance used venue-based sampling methods to recruit and interview MSM in 23 U.S. urban areas in 2017. We estimated the prevalence of sexual violence and examined associations between sexual violence and PrEP discussion with a health care provider (HCP) or PrEP use among HIV-negative MSM in the past 12 months. We reported weighted percentages and 95% confidence intervals (CI). Adjusted prevalence ratios (aPR) with 95% CIs were calculated using logistic regression with predicted margins to compare groups. Results Among 7,121 HIV-negative MSM, 4.2% (95% CI: 3.6%-4.8%) experienced sexual violence in the past 12 months. Sexual violence was not independently associated with PrEP discussion with HCP (47.6% vs. 40.0%; aPR = 1.16, 95% CI: 0.98-1.37). MSM who experienced sexual violence were more likely to use PrEP than those who did not experience sexual violence, even after adjusting for demographic differences (34.9% vs. 25.7%; aPR = 1.34, 95% CI: 1.07-1.67). Conclusions Overall PrEP discussion and PrEP use were low among HIV-negative MSM. PrEP use was higher among MSM who experienced sexual violence. Supportive patient-provider relationships that foster PrEP discussion and sexual violence screening in healthcare settings may be important to identifying HIV risk and PrEP needs while assessing MSM’s safety. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement National HIV Behavioral Surveillance (NHBS) is funded by the Centers for Disease Control and Prevention (CDC) through a cooperative agreement with state and local health departments. This project was supported in part by an appointment to the Research Participation Program at the CDC administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the CDC. The findings and conclusions of this analysis are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All National HIV Behavioral Surveillance (NHBS) participants provided informed consent. NHBS was determined by the Centers for Disease Control and Prevention to be a routine disease surveillance system and therefore exempted from IRB review. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data analyzed are not publicly available.