Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians

Abstract

BackgroundBefore Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. Before PrEP availability in Italy, we aimed to assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals, whether they knew people who were on PrEP, and describe the level of awareness and discussion on this preventive measure among them and people in their close circle.MethodsTwo anonymous questionnaires investigating personal characteristics and PrEP awareness, knowledge, and experience were proposed to HIV specialists and their patients on ARVs in a one-week, cross-sectional survey (December 2013–January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was conducted to identify factors associated with PrEP discussion with peers (close circle and/or HIV associations), and experience (use in close circle and/or personal ARV sharing).ResultsEighty-seven specialists in 31 representative Infectious Diseases departments administered the questionnaire to 1405 PLWHA. Among specialists, 98% reported awareness, 65% knew the dosage schedule, and 14% had previously suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or had direct or indirect experience of PrEP: 38% “had heard” of PrEP, 24% were aware of studies in HIV-negative individuals demonstrating a risk reduction through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP use in close circle and 1% personal ARV sharing. Factors predictive of either PrEP discussion with peers or experience differed between men and women, but across all genders were mainly related to having access to information, with HIV association membership being the strongest predictor.ConclusionsAt a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in Italy, a significant number of PLWHA were aware of it, and approximately 10% reported PrEP use in their close circle, although they rarely shared their ARVs with uninfected people for this purpose. Official policies and PrEP availability, along with implementation programs, could avoid risks from uncontrolled PrEP procurement and self-administration practices.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2819-5) contains supplementary material, which is available to authorized users.

“Yes, I’m interested in taking PrEP!”: PrEP interest among women respondents to the European community-based survey “Flash! PrEP in Europe”

“…Women in this study had a higher level of knowledge compared to other studies based on at risk women in the US in which PrEP knowledge ranged from almost 0 to 33% [ 23 , 61 , 63 ]. This result may be a consequence of the population sampled here, who may be more connected to HIV prevention services and organizations [ 64 ]. Regarding PrEP interest, women in this study expressed relatively low (18.0%) interest, which is comparable to another US study citing only 20% willingness to use PrEP among Caribbean immigrant women, but contrasts with other reports of high (60–65%) interest among at risk women in the US and internationally [ 23 , 60 , 61 , 65 ].…”

Mapping Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China

“…This result is consistent with previous studies among sexually active MSM before oral FTC/TDF was licensed for HIV prevention in other settings. 21,[68][69][70] We also observed that some informal PrEP users did not seek medical advice before initiation nor were they adherent to the dosing or quarterly testing schedule. Suboptimal use of PrEP in a medically unsupervised way poses both health risks to the users as well as implementation challenges and ethical issues to HIV prevention programs.…”

Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM)

“…In the second section, sexual behavior and habits were evaluated (items 7–22). These items were adapted from a published study [ 15 ] and from an online survey conducted in Spain in 2017 [ 12 ]. We added two items regarding the relational life of the subject (items 9–10), as the presence of different kinds of relation has been previously associated with risky behaviors [ 18 ].…”

“…Another study was conducted in Italy in order to evaluate knowledge, attitudes and practices regarding PrEP and antiretroviral therapy in a sample of persons living with HIV/acquired immune deficiency syndrome (AIDS) patients. In this study, 45.6% of the patients stated that they were informed about PrEP; however, this result comes from a highly selected sample, informed about HIV and in contact with an infectious disease specialist [ 15 ]. Hence, this sample is not representative of the population which can obtain the highest benefit from PrEP use, namely HIV-negative subjects at high risk of contagion, such as MSM.…”