Living While Black, Gay, and Poor: The Association of Race, Neighborhood Structural Disadvantage, and PrEP Utilization Among a Sample of Black Men Who Have Sex With Men in the Deep South

AIDS Educ Prev. 2021 Oct;33(5):395-410. doi: 10.1521/aeap.2021.33.5.395.


Utilizing the Andersen Healthcare Utilization Model, we examined the role of neighborhood context on pre-exposure prophylaxis (PrEP) utilization among a sample of Black men who have sex with men (MSM) residing in a medium-sized city in the Deep South. Data were derived from a sample of 142 Black MSM aged 18-64 years who were eligible for PrEP from a community-based study known as "ACCELERATE!" We used multilevel structural equation modeling to assess PrEP use. Social support, sexual risk, and health care access were predictive of PrEP use. Notably, residing in a neighborhood with concentrated poverty was associated with decreased PrEP use. Our findings reveal neighborhood structural disadvantage is associated with decreased PrEP use among Black MSM, after adjusting of individual-level sociodemographic characteristics. There is an urgent need to develop HIV prevention interventions and programs that explicitly address structural-level factors to eliminate racial/ethnic differences in HIV.

Keywords: Black MSM; HIV; PrEP; macrosocial determinants; neighborhood structural disadvantage; structural discrimination.

MeSH terms

  • Anti-HIV Agents* / therapeutic use
  • HIV Infections* / prevention & control
  • Homosexuality, Male
  • Humans
  • Male
  • Pre-Exposure Prophylaxis*
  • Sexual Behavior
  • Sexual and Gender Minorities*


  • Anti-HIV Agents