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Whiteley D, Strongylou D, Brown S, Vickerman P, Frankis JS. Hepatitis C testing among three distinct groups of gay, bisexual and other men who have sex with men: a cross-sectional study in the Celtic nations. Sex Transm Infect 2023; 99:440-446. [PMID: 37045586 DOI: 10.1136/sextrans-2023-055758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE The hepatitis C virus (HCV) epidemic among gay, bisexual and other men who have sex with men (GBMSM) is associated with sexual and drug-related behaviours. To stem the tide of HCV infection in GBMSM, regular testing leading to early diagnosis and treatment as prevention is vital. This study aimed to evaluate the success of current HCV testing guidelines from the perspective of GBMSM in four Celtic nations. METHODS Subpopulation analysis of data from the 2020 cross-sectional online SMMASH3 (social media, men who have sex with men, sexual and holistic health) survey was undertaken to examine HCV testing experiences and sexual behaviours among sexually active GBMSM (n=1886) stratified across three groups: HIV-diagnosed GBMSM (n=124); HIV-negative GBMSM using pre-exposure prophylaxis (PrEP) (n=365); and HIV-negative/untested GBMSM not using PrEP (n=1397). RESULTS Sexual behaviours associated with HCV acquisition were reported by the majority of HIV-diagnosed (76.6%, n=95) and PrEP-using (93.2%, n=340) GBMSM. Reassuringly, recent testing for HCV in these groups was common, with 79.8% (n=99) and 80.5% (n=294) self-reporting HCV screening within the preceding year, respectively, mostly within sexual health settings. While 54.5% (n=762) of HIV-negative/untested GBMSM not using PrEP reported sexual behaviours associated with HCV, 52.0% had not been screened for HCV in the last year, despite almost half (48.0%, n=190) of unscreened men being in contact with sexual health services in the same period. CONCLUSIONS Sexual behaviours associated with HCV acquisition among HIV-diagnosed and PrEP-using GBMSM are common but complemented by regular HCV testing within sexual health services. Current testing guidelines for these groups appear to be effective and generally well observed. However, behaviour-based HCV testing for HIV-negative/untested GBMSM not using PrEP appears less effective and may undermine efforts to achieve HCV elimination. Accordingly, we need to increase HCV testing for these men in clinical settings and explore ways to screen those who are not in touch with sexual health services.
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Affiliation(s)
- David Whiteley
- Department of Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Dimitra Strongylou
- Department of Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Sally Brown
- School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Peter Vickerman
- Bristol Population Health Science Institute, Bristol University, Bristol, UK
| | - Jamie Scott Frankis
- Department of Nursing and Community Health, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
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Coukan F, Murray KK, Papageorgiou V, Lound A, Saunders J, Atchison C, Ward H. Barriers and facilitators to HIV Pre-Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum. HIV Med 2023; 24:893-913. [PMID: 37078101 DOI: 10.1111/hiv.13492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) delivery in the UK is inequitable; over 95% of PrEP users were men who have sex with men (MSM) despite making up less than 50% of new HIV diagnoses. We conducted a systematic review to identify modifiable barriers and facilitators to PrEP delivery in the UK among underserved populations. METHODS We searched bibliographic/conference databases using the terms HIV, PrEP, barriers, facilitators, underserved populations, and UK. Modifiable factors were mapped along the PrEP Care Continuum (PCC) to identify targets for interventions. RESULTS In total, 44 studies were eligible: 29 quantitative, 12 qualitative and three mixed-methods studies. Over half (n = 24 [54.5%]) exclusively recruited MSM, whereas 11 were in mixed populations (all included MSM as a sub-population) and the other nine were in other underserved populations (gender and ethnicity minorities, women, and people who inject drugs). Of the 15 modifiable factors identified, two-thirds were at the PrEP contemplation and PrEParation steps of the PCC. The most reported barriers were lack of PrEP awareness (n = 16), knowledge (n = 19), willingness (n = 16), and access to a PrEP provider (n = 16), whereas the more reported facilitators were prior HIV testing (n = 8), agency and self-care (n = 8). All but three identified factors were at the patient rather than provider or structural level. CONCLUSIONS This review highlights that the bulk of the scientific literature focuses on MSM and on patient-level factors. Future research needs to ensure underserved populations are included and prioritized (e.g. ethnicity and gender minorities, people who inject drugs) and provider and structural factors are investigated.
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Affiliation(s)
- Flavien Coukan
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Keitumetse-Kabelo Murray
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Vasiliki Papageorgiou
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
| | - John Saunders
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Christina Atchison
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Helen Ward
- National Institute for Health Research Applied Research Collaboration North West London, Chelsea and Westminster Hospital, London, UK
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
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3
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Wagner GA, Wu KS, Anderson C, Burgi A, Little SJ. Predictors of Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) Uptake in a Sexual Health Clinic With Rapid PrEP Initiation. Open Forum Infect Dis 2023; 10:ofad060. [PMID: 36968957 PMCID: PMC10034584 DOI: 10.1093/ofid/ofad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Background Improved pre-exposure prophylaxis (PrEP) uptake is essential for human immunodeficiency virus (HIV) prevention initiatives. Offering PrEP at the time of HIV and sexually transmitted infection (STI) testing can improve uptake. We offered rapid PrEP initiation in a sexual health clinic and assessed predictors of PrEP interest, initiation, linkage, and retention. Methods Between November 2018 and February 2020, PrEP-eligible individuals who presented to a sexual health clinic were offered a free 30-day supply of PrEP plus linkage to continued PrEP care. Univariable and multivariable analyses of demographic and HIV risk data were conducted to determine predictors of PrEP uptake. Results Of 1259 adults who were eligible for PrEP (99.7% male, 42.7% White, 36.2% Hispanic), 456 were interested in PrEP, 249 initiated PrEP, 209 were linked, and 67 were retained in care. Predictors of PrEP interest included younger age (P < .01), lower monthly income (P = .01), recreational drug use (P = .02), and a greater number of sexual partners (P < .01). Negative predictors of PrEP initiation included lower monthly income (P = .04), testing positive for chlamydia (P = .04), and exchanging money for sex (P = .01). Negative predictors of linkage included self-identifying as Black (P = .03) and testing positive for an STI (P < .01). Having health insurance positively predicted both linkage (P < .01) and retention (P < .03). Conclusions A minority of PrEP-eligible HIV and STI testers initiated PrEP when offered, suggesting that easy PrEP access in sexual health clinics alone may not improve uptake. Predictors of uptake included established HIV risk factors and markers of higher socioeconomic status, suggesting that those aware of their risk and with the means to utilize health services engaged best with this model.
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Affiliation(s)
- Gabriel A Wagner
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Kuan-Sheng Wu
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Christy Anderson
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Alina Burgi
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, USA
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Lions C, Laroche H, Mora M, Pialoux G, Cotte L, Cua E, Piroth L, Molina JM, Salnikova M, Maradan G, Poizot-Martin I, Spire B. Missed opportunities for HIV pre-exposure prophylaxis among people with recent HIV infection: The French ANRS 95041 OMaPrEP study. HIV Med 2023; 24:191-201. [PMID: 35943165 DOI: 10.1111/hiv.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 07/06/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Our objective was to identify missed opportunities for the use of pre-exposure prophylaxis (PrEP) in people with recently acquired HIV, factors associated with PrEP knowledge, and reasons for not using PrEP. DESIGN This was a French national cross-sectional multicentre study enrolling people diagnosed with recent HIV (incomplete Western blot or negative HIV test in the previous 6 months) in 28 HIV clinical centres. Data were gathered using a self-administered questionnaire (SAQ). METHOD We analysed missed opportunities for PrEP use via a retrospective prep cascade. Factors associated with prior knowledge of PrEP and reasons for PrEP non-use among those who knew about PrEP were described using univariate and multivariate logistic regression models. RESULTS Of the 224 eligible patients, 185 completed the SAQ and 168 (91%) were eligible for PrEP. Of these, 90% reported seeing at least one physician during the previous year, 26% received information about PrEP, and 5% used PrEP. Factors independently associated with a higher probability of knowing about PrEP were being a man who has sex with men, being aged 25-30 years (vs older), undergoing HIV screening at least once every semester (vs less often; odds ratio [OR] 4.11; 95% confidence interval [CI] 2.00-8.45), and practicing chemsex (OR 3.19; 95% CI 1.12-9.10). Fear of side effects and a low perceived risk of HIV infection were the two most common reasons for not using PrEP (N = 40 [33.33%] and N = 34 [28.3%], respectively). CONCLUSIONS We found two gaps in the retrospective PrEP cascade: insufficient provision of PrEP information by healthcare providers (mainly general practitioners) and low PrEP acceptability by informed, eligible patients. More diverse healthcare providers need to be involved in PrEP prescription, and at-risk people need to be sensitized to the risk of HIV infection.
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Affiliation(s)
- Caroline Lions
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France
| | - Helene Laroche
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France
| | - Marion Mora
- Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Gilles Pialoux
- Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Maladies Infectieuses, Sorbonne Université, Paris, France
| | - Laurent Cotte
- Maladies Infectieuses, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Eric Cua
- Maladies Infectieuses, Hôpital L'Archet, Nice, France
| | - Lionel Piroth
- Département d'infectiologie, CHU Dijon Bourgogne, INSERM CIC1432 Université de Bourgogne, Dijon, France
| | - Jean Michel Molina
- Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM UMR 944, Biologie Cellulaire des Infections Virales, Paris, France.,Université de Paris, Paris, France
| | - Maria Salnikova
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France
| | - Gwenaëlle Maradan
- Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Isabelle Poizot-Martin
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France.,Immunohematology Clinical Uni, APHM, INSERM, IRD, SESSTIM, ISSPAM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
| | - Bruno Spire
- Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
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Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China. Sci Rep 2022; 12:20542. [PMID: 36446859 PMCID: PMC9707149 DOI: 10.1038/s41598-022-24965-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective strategy to prevent uninfected individuals from contracting human immunodeficiency virus (HIV), however it must be acceptable to stakeholders in order to be effective. This study aimed to assess the acceptability of PrEP and related influencing factors. A cross-sectional survey was conducted among female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM) using respondent driven sampling. Factors influencing PrEP acceptability were estimated using ordinal logistic regression and Bayesian networks. The survey included 765 eligible participants. The mean score of the perceived acceptability index was 3.9 (SD = 1.97). Multivariable logistic regression analysis revealed a higher acceptance of PrEP was associated with elder age, having other medical insurance, higher perceived utility of PrEP in facilitating prevention of HIV, higher perceived ease of use, higher perceived risk of increased risk behavior, higher perceived privacy problem in using PrEP, higher perceived comparative advantage over condom use, higher perceived comparative advantage of having sex when the urge arises, and higher perceived image of PrEP user as having sexual risky behavior, as public-minded and as health-conscious. The Bayesian network model showed perceived ease of use, perceived image of user as health-conscious, and perceived comparative advantage of having sex when the urge arises were directly associated with acceptability of PrEP. If these three factors were at a high level, 74.6% of the participants would have a high level of acceptability of PrEP. Effective education strategies to promote the acceptance of PrEP are needed. Implementation strategies should incorporate more inclusive messaging and build positive publicity for PrEP to reduce the stigma that PrEP use indicates risky behavior.
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Pingarilho M, Pimentel V, Miranda MNS, Silva AR, Diniz A, Ascenção BB, Piñeiro C, Koch C, Rodrigues C, Caldas C, Morais C, Faria D, da Silva EG, Teófilo E, Monteiro F, Roxo F, Maltez F, Rodrigues F, Gaião G, Ramos H, Costa I, Germano I, Simões J, Oliveira J, Ferreira J, Poças J, da Cunha JS, Soares J, Henriques J, Mansinho K, Pedro L, Aleixo MJ, Gonçalves MJ, Manata MJ, Mouro M, Serrado M, Caixeiro M, Marques N, Costa O, Pacheco P, Proença P, Rodrigues P, Pinho R, Tavares R, de Abreu RC, Côrte-Real R, Serrão R, Castro RSE, Nunes S, Faria T, Baptista T, Martins MRO, Gomes P, Mendão L, Simões D, Abecasis A. HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019. Front Microbiol 2022; 13:823208. [PMID: 35558119 PMCID: PMC9090520 DOI: 10.3389/fmicb.2022.823208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
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Affiliation(s)
- Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Mafalda N S Miranda
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Ana Rita Silva
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Diniz
- Unidade de Imunodeficiência, Centro Hospitalar Universitário Lisboa Norte - HPV, Lisbon, Portugal
| | | | - Carmela Piñeiro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmo Koch
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Rodrigues
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Caldas
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Célia Morais
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Domitília Faria
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | - Eugénio Teófilo
- Serviço de Medicina, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fátima Monteiro
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fausto Roxo
- Hospital de Dia de Doenças Infeciosas, Hospital Distrital de Santarém, Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fernando Rodrigues
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilhermina Gaião
- Serviço de Patologia Clínica, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Helena Ramos
- Serviço de Patologia Clínica, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Costa
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Simões
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Doenças, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | | | - Jorge Soares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Júlia Henriques
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Pedro
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | | | - Maria José Manata
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Serrado
- Unidade de Imunodeficiência, Centro Hospitalar Universitário Lisboa Norte - HPV, Lisbon, Portugal
| | - Micaela Caixeiro
- Serviço de Infeciologia, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, Almada, Portugal
| | - Olga Costa
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Rodrigues
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Pinho
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Infeciologia, Unidade de Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Rita Côrte-Real
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Sofia Nunes
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Telo Faria
- Unidade Local de Saúde do Baixo Alentejo, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Teresa Baptista
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Maria Rosário O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Costa da Caparica, Portugal
| | - Luís Mendão
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
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7
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Enebeli S, Okpalauwaekwe U, Mondal PK, Opondo J, Leis A. Interest In and Uptake of HIV Pre-Exposure Prophylaxis (PrEP): A Cross-Sectional Study of High-Risk Patients in Western Canada. Cureus 2022; 14:e24279. [PMID: 35607556 PMCID: PMC9123345 DOI: 10.7759/cureus.24279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Rationale Pre-exposure prophylaxis (PrEP) is a highly effective, evidence-based HIV prevention strategy. However, its use in the city of Saskatoon, Saskatchewan province of western Canada, is relatively new. Therefore, this study aimed to examine the interest and uptake of PrEP and investigate factors associated with HIV PrEP by high-risk patients. Methods A cross-sectional, self-administered survey of patients attending Saskatoon’s Public Health Services Sexual Health Clinic was conducted from October until December 2018. The primary outcome was the interest in taking PrEP to reduce the risk of HIV infection. This outcome was evaluated for its association with potential correlates, which included: sociodemographic characteristics, HIV risk perception, prior PrEP awareness, and sexual behaviors/lifestyles. Descriptive, univariate, and multivariate analyses were used to pursue our research objectives. Results One hundred forty-one participants were recruited from a sexual health clinic in Saskatoon. The median age (interquartile range) was 26 (22-31) years. The median number of partners (interquartile range) was 3 (2-4) partners. A total of 66.0% of participants were unaware of PrEP, and almost half ( 49.6%) indicated an interest in taking PrEP. Among those disinterested in PrEP, 49.3% perceived minimal HIV risk, 35.2% expressed concern regarding side effects, 28.1% cited the added need for condom use, 23.9% indicated incomplete effectiveness, and 22.5% did not wish to undergo regular bloodwork. Multivariate analysis showed that interested patients were more likely to have been previously aware of PrEP (OR: 2.6, p-value = 0.03), perceived themselves to be vulnerable to HIV (OR: 15.7, p = <0.0001), or were unsure about their risk (OR: 3.9, p = 0.001). Conclusion This study suggests that a lack of knowledge regarding personal HIV risk and PrEP as a preventive option may influence PrEP interest. There lies a need for more health promotion campaigns around the health benefits of PrEP, including literacy efforts on HIV risk, concerns around side effects, and associated blood work with PrEP use.
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8
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Zhou L, Assanangkornchai S, Shi Z, Jiang F, Yang D, Shi W. Acceptability of Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis among Men Who Have Sex with Men in Guilin, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063579. [PMID: 35329266 PMCID: PMC8951311 DOI: 10.3390/ijerph19063579] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022]
Abstract
Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are both effective strategies for preventing HIV. There is limited information about the acceptability of these prevention measures in undeveloped areas of China. We aimed to examine the acceptability of PrEP and nPEP and their determinants among men who have sex with men (MSM). 219 MSM were recruited in Guilin, China. In total, 28.6% (95% CI: 20.0–41.0) and 35.9% (95% CI: 27.3–49.5) of the participants had heard of PrEP and nPEP, respectively, while 57.0% (95% CI: 43.1–68.2) and 58.6 (95% CI:44.8–68.8) reported they would be willing to use PrEP and nPEP after the methods were explained. A higher acceptability of PrEP was seen among participants who were previously married (aOR = 3.30; 95% CI: 1.22–9.19), working as a laborer (aOR = 5.13; 95% CI: 1.64–17.59), migrant workers/farmers (aOR = 2.56; 95% CI: 1.15–5.79), government employees (aOR = 4.76; 95%CI: 1.80–13.02), had higher social support (aOR = 1.05; 95% CI: 1.03–1.08), and had been previously tested for HIV (aOR = 2.79; 95% CI: 1.36–5.94). A higher acceptability of nPEP was associated with those having higher social support (aOR = 1.06; 95% CI: 1.04–1.09), not knowing their sexual partner’s HIV status (aOR = 2.72; 95% CI: 1.23–6.12), and having a prior HIV test (aOR = 5.53; 95% CI: 2.58–12.51). PrEP and nPEP are acceptable, especially among MSM with higher social support and had received a previous HIV test. Effective education and different dissemination strategies to promote the acceptance of PrEP and nPEP among MSM are needed.
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Affiliation(s)
- Lingmi Zhou
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;
- Correspondence: (S.A.); (W.S.)
| | - Zhaohui Shi
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Fusheng Jiang
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Dong Yang
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Wuxiang Shi
- Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin 541004, China
- Correspondence: (S.A.); (W.S.)
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9
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Ssuna B, Katahoire A, Armstrong-Hough M, Kalibbala D, Kalyango JN, Kiweewa FM. Factors associated with willingness to use oral pre-exposure prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda. BMC Public Health 2022; 22:468. [PMID: 35264123 PMCID: PMC8905810 DOI: 10.1186/s12889-022-12859-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence. OBJECTIVE To examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV. METHODS We conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members in which PrEP had not been rolled out yet by the time of we conducted the study. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP. KEY RESULTS We enrolled 283 participants with a mean age of 31 ± 8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6, 95%CI 75.5-85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31-3.02, P = 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03-1.24, P = 0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39-2.81, P < 0.001). In focus group discussions, participants described pill burden, side-effects and drug safety as potential barriers to PrEP use. CONCLUSIONS AND RECOMMENDATIONS Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also increase means of awareness of PrEP as an HIV preventive strategy .
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Affiliation(s)
- Bashir Ssuna
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda. .,Uganda Tuberculosis Implementation Research Collaboration (U-TIRC), P.O. Box 21696, Kampala, Uganda.
| | - Anne Katahoire
- Makerere College of Health Sciences, Child Health and Development Centre, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Collaboration (U-TIRC), P.O. Box 21696, Kampala, Uganda.,Department of Social and Behavioral Sciences, Department of Epidemiology, New York University School of Global Public Health, New York, USA
| | - Dennis Kalibbala
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda.,Makerere University-John Hopkins University Research Collaboration (MU-JHU), Kampala, Uganda
| | - Joan N Kalyango
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda
| | - Flavia Matovu Kiweewa
- Department of Epidemiology and Biostatistics, Makerere College of Health Sciences, P.O. Box 21696, Kampala, Uganda.,Makerere University-John Hopkins University Research Collaboration (MU-JHU), Kampala, Uganda
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10
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Dunn M, Barnett A, McKay FH. Pre-exposure prophylaxis (PrEP) in Australia: are there challenges facing sexual health promotion? Health Promot Int 2021; 37:6409954. [PMID: 34695188 DOI: 10.1093/heapro/daab177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) for HIV refers to the daily use of antiretroviral medications by HIV uninfected persons to block a potential HIV infection. There is evidence to show that as the use of PrEP increases, the use of other safer sex practices such as condoms decreases, which may lead to an increase in sexually transmitted infections (STIs). This study aimed to explore whether PrEP had caused any challenges for organizations undertaking sexual health promotion activities in Australia. In-depth, semi-structured interviews were conducted with 17 participants (15 males, 2 females) who were purposively sampled from a range of HIV advocacy and health promotion settings. These included publicly funded HIV/AIDS councils and organizations representing people living with HIV/AIDS. Guided by an exploratory, inductive approach, the interviews were analyzed using thematic analysis. Three themes were constructed from the data analysis. First, organizations in different jurisdictions came to support PrEP in different ways, and this influenced the way organizations engaged with PrEP and the messaging that they disseminated to their community. Second, organizations faced some barriers to promoting PrEP, with the most significant being overcoming decades of HIV prevention campaigns that focused on barrier methods only. Third, there were social benefits to PrEP, such as shifting the onus of preventing HIV transmission from HIV positive to HIV negative people. PrEP is a highly effective biomedical intervention to reduce HIV transmission, and future challenges include designing campaigns for those at risk for HIV transmission outside the MSM community.
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Affiliation(s)
- Matthew Dunn
- School of Health and Social Development, Faculty of Health, Locked Bag 20001, Geelong, VIC 3220, Australia
| | - Anthony Barnett
- Turning Point, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Fiona H McKay
- School of Health and Social Development, Faculty of Health, Locked Bag 20001, Geelong, VIC 3220, Australia
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11
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Goodwin G. Social Media, Grindr, and PrEP: Sexual Health Literacy for Men Who Have Sex with Men in the Internet Age. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2021. [DOI: 10.1080/15398285.2021.1902227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Gavin Goodwin
- School of Information Studies, McGill University, Montreal, Canada
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12
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Chen W, Ding Y, Chen J, Zhao P, Wang Z, Meng X, Jia T, Zheng H, Yang B, Luo Z, Zou H. Awareness of and Preferences for Preexposure Prophylaxis (PrEP) among MSM at High Risk of HIV Infection in Southern China: Findings from the T2T Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6682932. [PMID: 33869634 PMCID: PMC8035020 DOI: 10.1155/2021/6682932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
This study is aimed at investigating the awareness of and preferences for oral and long-acting injectable HIV preexposure prophylaxis (PrEP) and their associated factors among men who have sex with men (MSM) at high risk of HIV infection in southern China. A cross-sectional survey was conducted among 603 MSM who were recruited through a cohort study called the T2T Study at three sexual health clinics in Guangzhou, Shenzhen, and Wuxi, China, from 2017 to 2018. We collected information on HIV-negative participants' awareness of and willingness to use PrEP and its potential correlations. Univariate and multivariate logistic regressions were used for data analyses. A total of 550 HIV-negative MSM were enrolled in the study. Less than half of at-risk MSM (43.1%) had heard of PrEP before, and the rate of overall willingness to use PrEP was 65.8%, while MSM were more willing to use daily oral PrEP than long-acting injectable- (LAI-) PrEP (62.2% vs. 38.5%). MSM who had university degrees or above (aOR = 1.55, 95% CI: 1.01-2.37), used condoms during last anal sex (1.52, 1.01-2.29), and tested 3 times or more for HIV (2.45, 1.10-5.47) were more likely to be aware of PrEP. MSM who had use of gay dating apps (1.51, 1.02-2.23), ever participated in HIV- or sexually transmitted disease (STD-) related studies (1.91, 1.24-2.94), and had heard of PrEP (3.06, 2.06-4.54) were more willing to use any regimen of PrEP. MSM at high risk of HIV infection had low awareness of PrEP and moderate willingness to use PrEP. Further studies of the implementation and promotion of PrEP targeting at-risk MSM should be performed.
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Affiliation(s)
- Weiying Chen
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Yi Ding
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Jianghao Chen
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Peipei Zhao
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago IL 60601, USA
| | - Zhenyu Wang
- Department of Medical Statistics, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China
| | - Xiaojun Meng
- Department of AIDS/STD Control and Prevention, Wuxi Center for Disease Control and Prevention, Wuxi 214000, China
| | - Tianjian Jia
- Department of AIDS/STD Control and Prevention, Wuxi Center for Disease Control and Prevention, Wuxi 214000, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou 510080, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou 510080, China
| | - Zhenzhou Luo
- Department of Dermatology and Venereology, Nanshan Center for Chronic Disease Control, Shenzhen 518054, China
| | - Huachun Zou
- Department of Medical Statistics, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China
- Kirby Institute, University of New South Wales, Sydney 1466, Australia
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13
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Chakrapani V, Newman PA, Shunmugam M, Rawat S, Baruah D, Nelson R, Roungkraphon S, Tepjan S. PrEP eligibility, HIV risk perception, and willingness to use PrEP among high-risk men who have sex with men in India: A cross-sectional survey. AIDS Care 2021; 34:301-309. [PMID: 33615903 DOI: 10.1080/09540121.2021.1887801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) is not yet included in India's national AIDS program, with demonstration projects for MSM in planning stages. In order to support PrEP roll-out for MSM, we assessed: (1) associations between guideline-informed PrEP eligibility, HIV risk perception, and perceived PrEP benefits and costs, with willingness to use PrEP (WTUP); and (2) correlates of non-WTUP among PrEP-eligible MSM. Data were collected from MSM (n = 197) sampled from cruising sites in Mumbai and Chennai. More than half (58.4%) reported inconsistent condom use with male partners, 88.3% >1 male partner, and 48.6% engaging in sex work (all past month). Overall, 76.6% reported they would "definitely use" PrEP. Among 92.9% deemed PrEP-eligible, 79.2% reported WTUP. In adjusted analyses, PrEP eligibility (aOR = 5.31, 95% CI 1.11, 25.45), medium (aOR = 2.41, 95% CI 1.03, 5.63) or high (aOR = 13.08, 95% CI 1.29, 132.27) perceived HIV risk, and greater perceived benefits (aOR = 1.13, 95% CI 1.03, 1.24) were associated with higher odds of WTUP. Among PrEP-eligible MSM, non-WTUP was associated with low HIV risk perception and lower perceived benefits. Facilitating accurate risk assessment and promoting awareness of PrEP benefits and eligibility criteria may increase PrEP uptake among MSM in India.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.,The Humsafar Trust, Mumbai, India
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | | | | | - Ruban Nelson
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Surachet Roungkraphon
- Faculty of Science and Technology, Rajamangala University of Technology Phra Nakhon, Bangkok, Thailand
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14
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PrEP Use Awareness and Interest Cascade among MSM and Transgender Women Living in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5040158. [PMID: 33050477 PMCID: PMC7709693 DOI: 10.3390/tropicalmed5040158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Indonesia has not implemented HIV pre-exposure prophylaxis (PrEP) despite global calls for its scale-up, and there is limited information about attitudes towards PrEP among its potential users. We aim to present a PrEP cascade among men who have sex with men (MSM) and transgender women (known locally as “waria”) in Denpasar, Bali, from a cross-sectional survey with 220 HIV-negative MSM/waria recruited from one clinic in Denpasar. Only 16.4% of participants had heard of PrEP before. From first-to-last steps included in the cascade, we found 77.3% (170/220) of participants were classified with HIV high risk, 75.9% (129/170) perceived themselves as being at high risk, 81.4% (105/129) expressed interest in using PrEP, 78.1% (82/105) were willing to do PrEP procedures, 48.8% (40/82) were willing to pay 500,000–600,000 IDR, and only two participants had ever been on PrEP before (5.0% of those willing to pay and 0.9% of the total sample). Multivariate logistic regression analysis showed that self-perception of high HIV risk was lower among older age groups (p < 0.001 among 30–39; p = 0.002 among > 40) and higher among participants with multiple sex partners (p = 0.016). Interest in using PrEP was lower among participants with high social engagement as MSM/waria (p = 0.002) and was higher among participants with multiple sex partners (p = 0.020) and inconsistent condom use (p = 0.011). This study has shown a significantly low level of PrEP awareness among its participants and decreases in interest in PrEP use due to procedure and cost. It suggested that an appropriate PrEP campaign is needed if PrEP is going to be introduced in Indonesia.
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15
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Herder T, Agardh A, Björkman P, Månsson F. Interest in Taking HIV Pre-exposure Prophylaxis Is Associated with Behavioral Risk Indicators and Self-Perceived HIV Risk Among Men Who Have Sex with Men Attending HIV Testing Venues in Sweden. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2165-2177. [PMID: 32495243 PMCID: PMC7316853 DOI: 10.1007/s10508-020-01740-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 05/29/2023]
Abstract
This study explored factors associated with interest in taking PrEP among men who have sex with men (MSM) attending HIV testing venues in Sweden. Data from 658 HIV-negative respondents, surveyed by a questionnaire at six sites, were analyzed descriptively and by univariable and multivariable logistic regression. A total of 453 (68.8%) of the respondents expressed interest in taking PrEP. Reporting self-perceived risk of HIV acquisition as moderate or high, reporting ≥ 5 partners for condomless anal intercourse during the past year, and reporting hard drug use during the past year were independently associated with interest in taking PrEP. However, an aggregated variable of self-reported rectal gonorrhea, rectal chlamydia, or syphilis infection during the past year was not associated with interest in taking PrEP. Overall, Swedish MSM were well-informed regarding PrEP, and interest in taking PrEP was positively associated with sexual risk indicators.
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Affiliation(s)
- Tobias Herder
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden.
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Malmö, Lund University, Jan Waldenströms gata 35, 214 28, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fredrik Månsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
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16
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Mabire X, Puppo C, Morel S, Mora M, Rojas Castro D, Chas J, Cua E, Pintado C, Suzan-Monti M, Spire B, Molina JM, Préau M. Pleasure and PrEP: Pleasure-Seeking Plays a Role in Prevention Choices and Could Lead to PrEP Initiation. Am J Mens Health 2020; 13:1557988319827396. [PMID: 30819060 PMCID: PMC6440035 DOI: 10.1177/1557988319827396] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pleasure-seeking plays a role in prevention (means choices and use), and in the sexual quality of life of men who have sex with men (MSM). Since HIV is a major threat to MSM health, new means of prevention, like pre-exposure prophylaxis (PrEP), must meet the needs of MSM to be fully efficient. Using a psychosocial approach, we examined how pleasure-seeking plays a role in participation of MSM in “ANRS-IPERGAY,” a community-based trial on sexual health which included sexual on-demand PrEP. Thirteen semistructured collective interviews were conducted with 45 participants. First, we analyzed participants’ search for new prevention means due to previous failures in condom use. We found that participants perceived condoms as a barrier—both materially and symbolically—to pleasure and desire, causing anxiety and stress considering sexual intercourse. Second, we explored representations and attitudes concerning pleasure within the context of PrEP. We found that PrEP allowed participants to freely choose their desired sexual positions and to better enjoy intimacy. Third, we studied the sexual quality of life for PrEP users in ANRS-IPERGAY and found an improvement. Thanks to the community-based design of the trial, this new prevention tool became a means to develop agency and empowerment for participants, not only in negotiating individual prevention but also in opposing the normative and stigmatizing discourse on sexuality and HIV. In conclusion, pleasure-seeking appears to be an essential element of sexual fulfillment that needs to be integrated as a positive notion in the study of HIV prevention.
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Affiliation(s)
| | | | | | - Marion Mora
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,4 ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Daniela Rojas Castro
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,5 Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | | | | | - Claire Pintado
- 8 Hospital Saint-Louis, Department of infectious Disease, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie Suzan-Monti
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,4 ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Bruno Spire
- 3 Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France.,4 ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Jean-Michel Molina
- 8 Hospital Saint-Louis, Department of infectious Disease, Assistance Publique Hôpitaux de Paris, Paris, France
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17
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Ogunbajo A, Leblanc NM, Kushwaha S, Boakye F, Hanson S, Smith MDR, Nelson LE. Knowledge and Acceptability of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Ghana. AIDS Care 2019; 32:330-336. [PMID: 31597455 DOI: 10.1080/09540121.2019.1675858] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Ghana, men who have sex with men (MSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a biomedical intervention that reduces the risk of HIV infection but is not currently available in Ghana. This paper explores knowledge and acceptability of HIV PrEP among Ghanaian MSM. Qualitative content analysis was conducted on 22 focus group discussions (N = 137) conducted between March and June 2012 in Accra, Kumasi, and Manya Krobo. Overall, participants reported low knowledge of PrEP. However, once information about PrEP was provided, there was high acceptability. The primary reason for acceptability was that PrEP provided an extra level of protection against HIV. Acceptability of PrEP was conditioned on it having minimal side effects, being affordable and efficient in preventing HIV infection. No acceptability of PrEP was attributed to limited knowledge of side effects and perceived lack of effectiveness. The reasons provided to utilize PrEP and condoms were that condoms protect against other STIs, and sexual partner factors. This is the first known study to explore PrEP knowledge and acceptability among Ghanaian MSM. It is important that key stakeholders preemptively address potential barriers to PrEP acceptability, uptake, and adherence, especially among MSM, once PrEP becomes available in Ghana.
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Affiliation(s)
- Adedotun Ogunbajo
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA
| | | | - Sameer Kushwaha
- University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | | | - Samuel Hanson
- Centre for Popular Education and Human Rights, Accra, Ghana
| | | | - LaRon E Nelson
- University of Rochester, School of Nursing, Rochester, NY, USA.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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18
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Soares F, MacCarthy S, Magno L, da Silva LAV, Amorim L, Nunn A, Oldenburg CE, Dourado I. Factors Associated with PrEP Refusal Among Transgender Women in Northeastern Brazil. AIDS Behav 2019; 23:2710-2718. [PMID: 30972620 PMCID: PMC9982655 DOI: 10.1007/s10461-019-02501-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Brazil has recently integrated HIV Pre-exposure Prophylaxis (PrEP) into its public health system and offered to key populations such as transgender women (TGW). This study investigates factors associated with PrEP refusal among TGW living in one of the largest and poorest cities of Brazil. We recruited 127 TGW using Respondent Driven Sampling (RDS) in Salvador, Brazil. Latent class analysis (LCA) was used to define acceptability of PrEP. Two latent classes were identified: "high acceptability of PrEP" (91.3%) and "PrEP refusal" (8.7%). PrEP was less acceptable among white TGW and among those age 25 or older, with income above minimum wage (≥ US$252.87), and reporting unprotected receptive anal intercourse with (URAI) causal partners. The findings highlight how nuanced strategies that takes into consideration unique characteristics are needed to effectively address the acceptability of PrEP.
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Affiliation(s)
- Fabiane Soares
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia, CEP: 40.110-040, Brazil.
| | | | - Laio Magno
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil,Department of Life Science, State University of Bahia (Universidade do Estado da Bahia/Departamento de Ciências da Vida), Salvador, BA, Brazil
| | - Luís Augusto Vasconcelos da Silva
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil,Institute of Humanities, Arts and Sciences Professor Milton Santos, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Humanidades, Artes e Ciências Professor Milton Santos), Salvador, BA, Brazil
| | - Leila Amorim
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil,Institute of Mathematics and Statistics, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Matemática e Estatística), Salvador, BA, Brazil
| | - Amy Nunn
- School of Public Health, Brown University, Providence, RI, USA
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil
| | - The PopTrans Group
- Institute of Collective Health, Federal University of Bahia (Universidade Federal da Bahia/Instituto de Saúde Coletiva), Rua Basílio da Gama, s/n, Campos Universitário do Canela, Salvador, Bahia CEP: 40.110-040, Brazil
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Sophus AI, Mitchell JW. A Review of Approaches Used to Increase Awareness of Pre-exposure Prophylaxis (PrEP) in the United States. AIDS Behav 2019; 23:1749-1770. [PMID: 30306434 DOI: 10.1007/s10461-018-2305-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PrEP is an important and useful HIV prevention strategy, yet awareness remains low among at-risk populations in the United States and elsewhere in the world. As previous studies have shown PrEP awareness to be important to PrEP uptake, understanding approaches to increase PrEP awareness is imperative. The current systematic review provides an overview of published articles and on-going research on PrEP awareness. Using PRISMA guidelines, two published articles and seven on-going research studies were identified that use different approaches to increase PrEP awareness. Findings highlight the need for research to target other at-risk populations and geographic areas. Future research should consider the use of technology and network approaches to assess whether they lead to increased awareness, accurate knowledge, and uptake of PrEP, along with examining which messaging works best for specific targeted, at-risk population(s).
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Affiliation(s)
- Amber I Sophus
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Rd, Biomed T110, Honolulu, HI, 96822, USA.
| | - Jason W Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, 1960 East-West Rd, Biomed T110, Honolulu, HI, 96822, USA
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20
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Dubin S, Goedel WC, Park SH, Hambrick HR, Schneider JA, Duncan DT. Perceived Candidacy for Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men in Paris, France. AIDS Behav 2019; 23:1771-1779. [PMID: 30250992 DOI: 10.1007/s10461-018-2279-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34-2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07-1.50, aRR 1.32; 95% CI 1.13-1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21-4.16, aRRR 2.58; 95% CI 1.09-6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03-0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions.
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21
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Wong CS, Kumar PA, Wong CM, Choong BCH, Lim OZ, Chan YY, Ibrahim MAB, Chio MT, Tan RKJ, Chen MI. Acceptability of HIV Pre-exposure Prophylaxis (PrEP) and Opinions on PrEP Service Delivery Among Men Who Have Sex With Men in Singapore: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:152-162. [PMID: 30917012 DOI: 10.1521/aeap.2019.31.2.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PrEP is effective in preventing HIV transmission among at-risk HIV-negative MSM. A qualitative descriptive study with five focus group discussions (N = 33) involving a purposively recruited sample of Singaporean MSM was conducted from August 2016 to April 2017 to understand local perspectives on potential barriers and motivators to the adoption of PrEP, prior to the implementation of PrEP services in Singapore. Knowledge of PrEP was high, and many viewed PrEP as an attractive alternative to condoms for HIV prevention. Concerns about PrEP included the cost of PrEP and related services, the frequency of PrEP-related clinic visits, fear of side effects, and the stigma associated with using PrEP. Participants felt PrEP was best provided by MSM-friendly providers, and more needed to be done to increase awareness of the effectiveness of PrEP. Access to PrEP for MSM in Singapore has to be affordable, patient-centered, and convenient to maximize the potential benefits of PrEP.
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Affiliation(s)
| | - P Arun Kumar
- National Centre for Infectious Diseases, Singapore
| | - Christina M Wong
- Behavioral, Epidemiological and Clinical Sciences, Durham, North Carolina
| | | | - Oliver Z Lim
- National Centre for Infectious Diseases, Singapore
| | - Yin Ying Chan
- Office of Clinical Epidemiology, Analytics, and Knowledge, Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Muhamad Alif Bin Ibrahim
- Office of Clinical Epidemiology, Analytics, and Knowledge, Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Martin T Chio
- Department of STI Control (DSC) Clinic, National Skin Centre, Singapore
| | - Rayner K J Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mark I Chen
- National Centre for Infectious Diseases, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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22
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Flowers P, Frankis J. Imagining Interventions for Collective Sex Environments. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:35-39. [PMID: 29748786 PMCID: PMC6349797 DOI: 10.1007/s10508-018-1222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Paul Flowers
- M420, Department of Psychology, George Moore Building, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - Jamie Frankis
- Department of Nursing, Glasgow Caledonian University, Glasgow, Scotland, UK
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23
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Iniesta C, Álvarez-del Arco D, García-Sousa LM, Alejos B, Díaz A, Sanz N, Garrido J, Meulbroek M, Pujol F, Moreno S, Fuster-Ruiz de Apocada MJ, Coll P, Antela A, del Romero J, Ayerdi O, Riera M, Hernández J, del Amo J. Awareness, knowledge, use, willingness to use and need of Pre-Exposure Prophylaxis (PrEP) during World Gay Pride 2017. PLoS One 2018; 13:e0204738. [PMID: 30339690 PMCID: PMC6195256 DOI: 10.1371/journal.pone.0204738] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the awareness, knowledge, use, and willingness to use and need of PrEP among men who have sex with men (MSM) and transgender women (TW) who attended World Gay Pride (WGP) 2017 in Madrid. DESIGN AND METHODS Online survey. Participants were recruited through gay-oriented dating apps and HIV Non-Governmental Organizations´ social media. Inclusion criteria included being MSM or TW, age 18 years old or above, and having attended WGP in Madrid. Information regarding the participant's awareness and knowledge, use or willingness to use, and need for PrEP was collected, as well as sociodemographic characteristics. Participants were considered to be in need of PrEP if they met one of the following indication criteria: having practiced unprotected anal intercourse with more than 2 partners, having practiced chemsex, or having engaged in commercial sex-all in the preceding 6 months. Descriptive and multivariable analyses with logistic regression were conducted. RESULTS 472 participants met the inclusion criteria and completed the questionnaire. The mean age was 38, 97.7% were MSM, 77% had a university education, and 85% were living in Spain, mostly in big cities. Overall, 64% of participants were aware of PrEP, but only 33% knew correctly what PrEP was. 67% of HIV-negative participants were willing to take PrEP, although only 5% were taking it during WGP, mostly due to lack of access. 43% of HIV-negative respondents met at least one PrEP indication criteria. For HIV-negative men living in Spain, university education and living in big cities was associated with PrEP awareness. Lower education level and meeting PrEP criteria was associated with willingness to use PrEP. CONCLUSIONS Our study shows that among MSM attending WGP 2017 in Madrid, there was limited PrEP awareness, low accuracy of PrEP knowledge, and a high need and willingness to use PrEP. Health authorities should strengthen existing preventive strategies and implement PrEP.
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Affiliation(s)
- Carlos Iniesta
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Débora Álvarez-del Arco
- Universidad Complutense de Madrid, Madrid, Spain
- La Doctora Álvarez Communication Agency, Madrid, Spain
| | | | - Belén Alejos
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Asunción Díaz
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | | | | | | | - Ferran Pujol
- Projecte dels NOMS, Hispanosida, Barcelona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad Alcalá de Henares, Madrid, Spain
| | | | - Pep Coll
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
| | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Infectious Diseases Department, Santiago de Compostela, Spain
| | | | - Oskar Ayerdi
- Centro Sanitario Sandoval IdISSC, Unidad ITS/VIH, Madrid, Spain
| | | | - Juanse Hernández
- Grupo de Trabajo sobre Tratamientos del VIH -gTt-VIH, Barcelona, Spain
| | - Julia del Amo
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
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24
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Williamson I, Papaloukas P, Jaspal R, Lond B. ‘There’s this glorious pill’: gay and bisexual men in the English midlands navigate risk responsibility and pre-exposure prophylaxis. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1497143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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25
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Nic Lochlainn L, O'Donnell K, Hurley C, Lyons F, Igoe D. Using data from a behavioural survey of men who have sex with men (MSM) to estimate the number likely to present for HIV pre-exposure prophylaxis (PrEP) in Ireland, 2017. ACTA ACUST UNITED AC 2018; 22. [PMID: 29208157 PMCID: PMC5725788 DOI: 10.2807/1560-7917.es.2017.22.48.17-00768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In Ireland, men who have sex with men (MSM) have increased HIV risk. Pre-exposure prophylaxis (PrEP), combined with safe sex practices, can reduce HIV acquisition. We estimated MSM numbers likely to present for PrEP by applying French PrEP criteria to Irish MSM behavioural survey data. We adjusted for survey bias, calculated proportions accessing testing services and those likely to take PrEP. We estimated 1-3% of MSM in Ireland were likely to present for PrEP.
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Affiliation(s)
- Laura Nic Lochlainn
- Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland
| | - Kate O'Donnell
- Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland
| | - Caroline Hurley
- Health Service Executive Sexual Health and Crisis Pregnancy Programme, Dublin, Ireland
| | - Fiona Lyons
- Health Service Executive Sexual Health and Crisis Pregnancy Programme, Dublin, Ireland
| | - Derval Igoe
- Health Service Executive Health Protection Surveillance Centre, Dublin, Ireland
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26
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Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, Zhang L. A Global Estimate of the Acceptability of Pre-exposure Prophylaxis for HIV Among Men Who have Sex with Men: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:1063-1074. [PMID: 28176168 DOI: 10.1007/s10461-017-1675-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a new biomedical intervention for HIV prevention. This study systematically reviews the acceptability of PrEP among men who have sex with men (MSM) worldwide. We searched major English databases to identify English-language articles published between July 2007 and July 2016, which reported the acceptability of PrEP and associated population characteristics. Meta-analysis was conducted to estimate a pooled acceptability, and meta-regression and subgroup analysis were used to analyse heterogeneities. The estimated acceptance from included sixty-eight articles was 57.8% (95% confidence internal 52.4-63.1%). MSM who were younger (4/5 studies, range of adjusted odds ratio (aOR) = 1.39-3.47), better educated (aOR = 1.49-7.70), wealthier (aOR = 1.31-13.03) and previously aware of PrEP (aOR = 1.33-3.30) showed significantly higher acceptance. Male sex workers (84.0% [26.3-98.7%] were more likely to accept PrEP than general MSM. Self-perceived low efficacy, concern about side effects, adherence, affordability, and stigma were main barriers. This review identifies a moderate acceptability of PrEP in MSM. Efficacy, perception of HIV risk and experienced stigma determine its acceptance.
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27
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Glynn RW, Byrne N, O'Dea S, Shanley A, Codd M, Keenan E, Ward M, Igoe D, Clarke S. Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:9-15. [PMID: 29223761 DOI: 10.1016/j.drugpo.2017.10.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug use for or during sex ('chemsex') among MSM has caused concern, because of the direct effects of the drugs themselves, and because of an increased risk of transmission of sexually transmitted infections (STIs). This study aimed to assess the prevalence of chemsex, associated behaviours and STIs among attendees at Ireland's only MSM-specific sexual health clinic in Dublin over a six week period in 2016. METHODS The questionnaire collected demographic data, information on sexuality and sexual practice, self-reported history of treatment for STIs, and chemsex use. Key variables independently associated with treatment for STIs over the previous 12 months were identified using multivariable logistic regression. RESULTS The response rate was 90% (510/568). One in four (27%) reported engaging in chemsex within the previous 12 months. Half had taken ≥2 drugs on his last chemsex occasion. One in five (23%) reported that they/their partners had lost consciousness as a result of chemsex. Those engaging in chemsex were more likely to have had more sexual partners(p<0.001), more partners for anal intercourse (p<0.001) and to have had condomless anal intercourse(p=0.041). They were also more likely to report having been treated for gonorrhoea over the previous 12 months (adjusted OR 2.03, 95% CI 1.19-3.46, p=0.009). One in four (25%) reported that chemsex was impacting negatively on their lives and almost one third (31%) reported that they would like help or advice about chemsex. CONCLUSION These results support international evidence of a chemsex culture among a subset of MSM. They will be used to develop an effective response which simultaneously addresses addiction and sexual ill-health among MSM who experience harm/seek help as a consequence of engagement in chemsex.
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Affiliation(s)
- Ronan W Glynn
- Department of Public Health Medicine, Dr. Steevens' Hospital, Dublin 8, Ireland; CTAR Biostatistics and Health Research, UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin 4, Ireland.
| | - Niamh Byrne
- Department of Public Health Medicine, Dr. Steevens' Hospital, Dublin 8, Ireland
| | - Siobhan O'Dea
- Gay Men's Health Service, Baggot Street Hospital, Dublin 2, Ireland
| | - Adam Shanley
- Gay Men's Health Service, Baggot Street Hospital, Dublin 2, Ireland
| | - Mary Codd
- CTAR Biostatistics and Health Research, UCD School of Public Health, Physiotherapy and Sports Science, Belfield, Dublin 4, Ireland
| | - Eamon Keenan
- Addiction Services, National Social Inclusion Office, Mill Lane, Palmerstown, Dublin 20, Ireland
| | - Mary Ward
- Department of Public Health Medicine, Dr. Steevens' Hospital, Dublin 8, Ireland
| | - Derval Igoe
- Health Protection Surveillance Centre,25-27 Middle Gardiner Street, Dublin 1, Ireland
| | - Susan Clarke
- Gay Men's Health Service, Baggot Street Hospital, Dublin 2, Ireland
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28
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Wilkinson AL, Draper BL, Pedrana AE, Asselin J, Holt M, Hellard ME, Stoové M. Measuring and understanding the attitudes of Australian gay and bisexual men towards biomedical HIV prevention using cross-sectional data and factor analyses. Sex Transm Infect 2017; 94:309-314. [PMID: 29162727 DOI: 10.1136/sextrans-2017-053375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Contemporary responses to HIV embrace biomedical prevention, particularly treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP). However, large-scale implementation of biomedical prevention should be ideally preceded by assessments of their community acceptability. We aimed to understand contemporary attitudes of gay and bisexual men (GBM) in Australia towards biomedical-based HIV prevention and propose a framework for their measurement and ongoing monitoring. METHODS A cross-sectional, online survey of GBM ≥18 years has been conducted annually in Victoria, Australia, since 2008. In 2016, 35 attitudinal items on biomedical HIV prevention were added. Items were scored on five-point Likert scales. We used principal factor analysis to identify key constructs related to GBM's attitudes to biomedical HIV prevention and use these to characterise levels of support for TasP and PrEP. RESULTS A total of 462 HIV-negative or HIV-status-unknown men, not using PrEP, provided valid responses for all 35 attitudinal items. We extracted four distinct and interpretable factors we named: 'Confidence in PrEP', 'Judicious approach to PrEP', 'Treatment as prevention optimism' and 'Support for early treatment'. High levels of agreement were seen across PrEP-related items; 77.9% of men agreed that PrEP prevented HIV acquisition and 83.6% of men agreed that users were protecting themselves. However, the agreement levels for HIV TasP items were considerably lower, with <20% of men agreeing treatment (undetectable viral load) reduced HIV transmission risk. CONCLUSIONS Better understanding of community attitudes is crucial for shaping policy and informing initiatives that aim to improve knowledge, acceptance and uptake of biomedical prevention. Our analyses suggest confidence in, acceptability of and community support for PrEP among GBM. However, strategies to address scepticism towards HIV treatment when used for prevention may be needed to optimise combination biomedical HIV prevention.
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Affiliation(s)
- Anna L Wilkinson
- Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Alisa E Pedrana
- Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | | | - Martin Holt
- Centre for Social Research in Health, Sydney, New South Wales, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.,Alfred Health, Infectious Disease Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark Stoové
- Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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29
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Goedel WC, Mayer KH, Mimiaga MJ, Duncan DT. Considerable interest in pre-exposure prophylaxis uptake among men who have sex with men recruited from a popular geosocial-networking smartphone application in London. Glob Public Health 2017; 14:112-121. [PMID: 29058524 DOI: 10.1080/17441692.2017.1391859] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Men who have sex with men (MSM) who use smartphone applications (apps) to meet sexual partners represent a high-risk subset of MSM. As such, the use of pre-exposure prophylaxis (PrEP) may be highly suitable. The purpose of the study was to evaluate awareness of and willingness to use PrEP among 179 HIV-uninfected MSM recruited in London who use these apps. Regression models were fit to assess the associations between perceived barriers and willingness to use PrEP in the future. Most (84.9%) had heard of PrEP and more than half (57.1%) were willing to use PrEP in the future if it were to become available. Low perceived risk for acquiring HIV (prevalence ratio (PR): 0.11; 95% confidence interval (CI): 0.04, 0.33) and concerns about PrEP-related side effects (PR: 0.01; 95% CI: 0.00, 0.04) were associated with being unwilling to use PrEP. Efforts to make PrEP widely available should be continued. Uptake interventions should focus on correcting self-perceptions of HIV risk and educate MSM about the potential side effects of PrEP use so that MSM can make more informed decisions about prevention options.
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Affiliation(s)
- William C Goedel
- a Department of Population Health, School of Medicine , New York University , New York , NY , USA.,b College of Global Public Health , New York University , New York , NY , USA.,c Department of Sociology, College of Arts and Science , New York University , New York , NY , USA
| | - Kenneth H Mayer
- d The Fenway Institute, Fenway Health , Boston , MA , USA.,e Department of Medicine , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , MA , USA
| | - Matthew J Mimiaga
- d The Fenway Institute, Fenway Health , Boston , MA , USA.,f Department of Epidemiology, School of Public Health , Brown University , Providence , RI , USA.,g Department of Behavioral & Social Health Sciences, School of Public Health , Brown University , Providence , RI , USA.,h Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , USA.,i Center for Health Equity Research , Brown University , Providence , RI , USA
| | - Dustin T Duncan
- a Department of Population Health, School of Medicine , New York University , New York , NY , USA.,b College of Global Public Health , New York University , New York , NY , USA
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30
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Lim SH, Mburu G, Bourne A, Pang J, Wickersham JA, Wei CKT, Yee IA, Wang B, Cassolato M, Azwa I. Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: Findings from an online survey. PLoS One 2017; 12:e0182838. [PMID: 28902857 PMCID: PMC5597127 DOI: 10.1371/journal.pone.0182838] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/25/2017] [Indexed: 12/02/2022] Open
Abstract
Objective We examined willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia. Methods An online survey of 990 MSM was conducted between March and April 2016. Eligibility criteria included being biological male, Malaysian citizen, 18 years of age or above, identifying as MSM, and being HIV negative or unknown status. Participants’ demographics, sexual and drug use behaviors, attitudes towards PrEP, and preferences regarding future access to PrEP were collected. Bivariate analysis and logistic regression were performed to determine factors associated with willingness to use PrEP. Results Fewer than half of participants (44%) knew about PrEP before completing the survey. Overall, 39% of the sample were willing to take PrEP. Multivariate logistic regression indicated that Malay men (AOR: 1.73, 95% CI:1.12, 2.70), having 2 or more male anal sex partners in the past 6 months (AOR: 1.98, 95% CI: 1.29, 3.05), previous knowledge of PrEP (AOR: 1.40, 95%CI: 1.06, 1.86), lack of confidence in practising safer sex (AOR: 1.36, 95% CI: 1.02, 1.81), and having ever paid for sex with a male partner (AOR: 1.39, 95% CI: 1.01, 1.91) were independently associated with greater willingness to use PrEP, while men who identified as heterosexual were less willing to use PrEP (AOR, 0.36, 95% CI: 0.13, 0.97). Majority of participants preferred to access PrEP at affordable cost below 100 Malaysian Ringgit (USD25) per month from community based organisations followed by private or government hospitals. Conclusions Overall, MSM in Malaysia reported a relatively low level of willingness to use PrEP, although willingness was higher among those previously aware of PrEP. There is a need to provide PrEP at affordable cost, increase demand and awareness of PrEP, and to provide access to this preventative medication via diverse, integrated and tailored sexual health services.
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Affiliation(s)
- Sin How Lim
- Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gitau Mburu
- Division of Health Research, University of Lancaster, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia.,Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joselyn Pang
- International Programs, Australian Federation of AIDS Organizations, Bangkok, Thailand
| | - Jeffrey A Wickersham
- Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America
| | | | | | - Bangyuan Wang
- Division of Health Research, University of Lancaster, United Kingdom
| | - Matteo Cassolato
- Division of Health Research, University of Lancaster, United Kingdom
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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31
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Gilson RI, Clutterbuck DJ, Chen ZE. Demand for pre-exposure prophylaxis for HIV and the impact on clinical services: Scottish men who have sex with men perspectives. Int J STD AIDS 2017; 29:273-277. [PMID: 28771076 DOI: 10.1177/0956462417723817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a lack of data on ability and willingness of men who have sex with men (MSM) to self-fund HIV pre-exposure prophylaxis (PrEP). We aimed to explore how many eligible (PROUD study criteria) men may want PrEP and how many lower-risk MSM would be willing and able to self-fund this intervention. A self-completed anonymous questionnaire was distributed to MSM populations attending services. Of 377 participants, 81.5% were aware of PrEP. Fifty-three (15.5 %) were eligible, of whom 43 (81%) were very/extremely likely to want it. Of those ineligible, 229 (80%) were aware of PrEP and 106 (37.3%) were very/extremely likely to want it. Of eligible respondents 23% would be willing and able to pay at least £50 a month for PrEP. Of ineligible respondents this proportion was 21%. Our survey revealed high levels of awareness, understanding and willingness to take PrEP among MSM at high and lower risk of HIV acquisition. It indicated that over 70% of high-risk men would be unwilling or unable to self-fund PrEP, should it not be available on the NHS. For lower-risk MSM we estimated that capacity requirements for monitoring self-funded PrEP will be 50% higher than numbers eligible for PrEP. These factors will need to be taken into account when planning services.
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Reyniers T, Hoornenborg E, Vuylsteke B, Wouters K, Laga M. Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool. Sex Transm Infect 2016; 93:363-367. [PMID: 27872326 DOI: 10.1136/sextrans-2016-052699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/09/2016] [Accepted: 10/29/2016] [Indexed: 11/04/2022] Open
Abstract
In many Western countries with good coverage of antiretroviral treatment (ART) programmes the annual number of HIV infections is still high and not (yet) declining among men who have sex with men (MSM). This might indicate that antiretroviral treatment roll-out alone will not turn around the course of the epidemic and that new, additional tools are needed. Antiretrovirals used as prevention tools for people not yet infected with HIV, such as pre-exposure prophylaxis (PrEP) could be such important additional tools. PrEP is a new type of biomedical prevention, which involves the use of antiretrovirals before, during and after (periods of) sexual exposure to HIV. In this review, we will focus on PrEP as a new prevention tool for MSM at high risk in Europe, including its evidence for effectiveness, challenges for implementation, ongoing European demonstration studies; as well as how PrEP relates to other existing prevention tools. In light of European Medicines Agency's recent recommendation for approval of PrEP we briefly review the potential implications.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Cassell JA. Highlights from this issue. Br J Vener Dis 2016. [DOI: 10.1136/sextrans-2016-052705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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