LAI-ART Awareness, Willingness, Barriers and Facilitators among Black Sexual Minority Men Living with HIV in the US South

Int J Environ Res Public Health. 2024 May 8;21(5):602. doi: 10.3390/ijerph21050602.

Abstract

Black sexual minority men (BSMM) continue to bear a disproportionate burden of HIV in the United States, with the highest incidence and prevalence in the southern region of the country. In Texas, BSMM living with HIV (BSMM+) have the lowest rates of viral suppression of all SMM and have lower antiretroviral treatment (ART) adherence than white and Hispanic SMM. Long-acting injectable ART (LAI-ART) can potentially overcome several barriers to daily oral ART adherence (e.g., stigma, forgetfulness, pill fatigue). However, little is known about the knowledge, willingness, barriers, and facilitators regarding LAI-ART among BSMM+. From July 2022 to September 2023, we conducted in-depth, semi-structured interviews with 27 BSMM+ from the Houston and Dallas Metropolitan Areas, Texas. Data were analyzed using a thematic analysis approach. Most men knew about LAI-ART, but their understanding varied based on their existing sources of information. Some men were enthusiastic, some were cautious, and some reported no interest in LAI-ART. Barriers to LAI-ART included a lack of public insurance coverage of LAI-ART; fear of needles and side effects; the frequency of injection visits; the requirement of viral suppression before switching from oral ART to LAI-ART; and satisfaction with oral daily ART. Motivators of LAI-ART uptake included the eliminated burden of daily pills and reduced anxiety about possibly missing doses. BSMM+ may be among those who could most benefit from LAI-ART, though more research is needed to understand which factors influence their willingness and how the barriers to LAI-ART might be addressed, particularly among diverse communities of SMM of color.

Keywords: HIV treatment; acceptability; adherence; black sexual minority men; long-acting injectable ART; willingness.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Black or African American / psychology
  • HIV Infections* / drug therapy
  • HIV Infections* / psychology
  • Health Knowledge, Attitudes, Practice*
  • Health Services Accessibility
  • Humans
  • Male
  • Medication Adherence / psychology
  • Middle Aged
  • Sexual and Gender Minorities* / psychology
  • Sexual and Gender Minorities* / statistics & numerical data
  • Texas
  • Young Adult

Substances

  • Anti-HIV Agents