Syphilis Diagnosis and Interest in Doxycycline Postexposure Prophylaxis Among Young Black Sexual and Gender...

Doxycycline postexposure prophylaxis (doxy-PEP) is a low-cost, effective strategy for preventing syphilis and other bacterial sexually transmitted infections among men who have sex with men and transgender women, yet doxy-PEP remains underused by young black sexual and gender minorities (YBSGM). This analysis examined sociodemographic, sexual health, and substance use factors associated with interest in doxy-PEP among a human immunodeficiency virus (HIV) status-neutral cohort of YBSGM.

The Neighborhoods and Networks Phase 2 (N2P2) cohort included YBSGM, and our primary outcome was interest in doxy-PEP. Generalized linear models were fit to calculate the unadjusted and adjusted relative risks (RRs) between interest in doxy-PEP and sociodemographic and health factors.

A total of 538 participants were included in the analysis, with 59.9% reporting interest in doxy-PEP. Participants interested in doxy-PEP were older (RR, 1.02 [95% confidence interval (CI), 1.00-1.04]; P = .04), more likely to be living with HIV (1.25 [1.08-1.44]; P < .01), and more likely to have a history of syphilis (1.45 [1.23-1.70]; P < .01). Self-report stimulant use (RR, 1.28 [95% CI, 1.15-1.53]; P < .01) and group sex (1.32 [1.15-1.53]; P < .01) were greater among those interested in doxy-PEP. When adjusted for age, HIV status, and stimulant use, history of syphilis (adjusted RR, 1.17 [95% CI, 1.05-1.31]; P = .01) and group sex (1.14 [1.02-1.28]; P = .02) remained associated with interest in doxy-PEP.

YBSGM who were interested in doxy-PEP were more likely to have had a syphilis diagnosis and participate in group sex. YBSGM with these risk factors represent an important demographic for the scale-up of doxy-PEP use.