Changes in Familiarity with and Willingness to Take Preexposure Prophylaxis in a Longitudinal Study of Highly Sexually Active Gay and Bisexual Men

Abstract

Purpose: For gay and bisexual men (GBM), research suggests that familiarity with preexposure prophylaxis (PrEP) has been increasing since being approved by the United States Food and Drug Administration in 2012. However, it is less clear how willingness to start using PrEP has changed over time. Likewise, some have expressed concerns regarding the potential for risk compensation (i.e., reduced condom use) were one to start PrEP; however, again, it is unclear how risk compensation may have changed over time. Methods: We conducted baseline and 12-month assessments with 158 highly sexually active HIV-negative GBM in New York City who were assessed between 2011 and 2014. We examined change over time both between participants (based on when they entered the study), as well as within each participant (over the 12 months of his involvement). Results: Familiarity with PrEP increased over time (both between and within participants); however, willingness to take PrEP did not change (neither between nor within participants). Few men believed taking PrEP would cause their condomless anal sex (CAS) to increase and this did not change over time. However, a majority believed PrEP would increase temptation for CAS, and this did not change over time within participants. Sexual compulsivity symptomology was associated with higher willingness to take PrEP and perceiving that PrEP would increase one's temptations for CAS. Furthermore, recent CAS was associated with greater willingness to take PrEP, a perception that PrEP would increase one's likelihood to engage in CAS, and a perception that being on PrEP would increase one's temptation for CAS. Conclusions: Participants became more familiar with PrEP over time; however, willingness to start PrEP did not change, and this may serve as an opportunity for providers to discuss PrEP with their patients. Men who engaged in CAS were interested in PrEP and preexisting patterns of sexual behavior may be the primary determinant of CAS while on PrEP.

Low Awareness and Use of Preexposure Prophylaxis in a Diverse Online Sample of Men Who Have Sex With Men in New York City

“…First, we used a convenience sample from a single mobile dating application, which may not be representative of all MSM in the Bronx, and findings may not be generalizable to other MSM communities. However, we found similar rates of PrEP awareness in other studies in New York City using different recruitment approaches (Grov et al, 2016; Mantell et al, 2014; Rucinski et al, 2013). Additionally, a prior in-person survey of Bronx MSM found widespread use of social media, with individuals using online dating applications having higher rates of risk behaviors (Patel et al, 2016), suggesting we reached a population that could benefit from PrEP.…”

“…Compared to other studies reporting on PrEP awareness in New York City MSM, which recruited using different approaches (in-person, bars, bathhouses, or via MSM specific Internet websites) and conducted prior to (Mantell et al, 2014; Rucinski et al, 2013) or after FDA approval of PrEP (Grov, Rendina, Whitfield, Ventuneac, & Parsons, 2016), rates of PrEP awareness were similar to that in our sample, ranging from 28% to 38.8%. Our findings may not be that surprising, given that this study was conducted just over 1 year after FDA approval of PrEP and the average time for new health care innovations to become widely known and adopted can be considerably long, as a more recent study of PrEP use in Black MSM found continued minimal awareness and thus stalled uptake (Eaton, Driffin, Bauermeister, Smith, & Conway-Washington, 2015).…”

Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool

“…However, such high awareness does not necessarily translate into a high PrEP uptake among MSM 8 11 12. Until 2 years after the US Food and Drug Administration (FDA) approval, PrEP uptake has been slow in the USA,13 14 and while it has risen significantly between 2013 and 2016, this increase is still relatively small, except for cities such as San Francisco and New York 15–17.…”

Using Online Settings to Identify Gay and Bisexual Men Willing to Take or With Experience Taking PrEP: Implications for Researchers and Providers

“…Though not consistently,(Eaton et al, 2014) researchers have found a positive association between a prior history of behaviors that would increase HIV acquisition risk and willingness to start PrEP (i.e., men who would be high priority candidates for PrEP based on their pre-existing behavior are more willing than others to start PrEP) (Gamarel & Golub, 2014; Golub, 2014; Grov, Rendina, et al, 2016; Grov, Whitfield, Rendina, Ventuneac, & Parsons, 2015; Parsons et al, 2016). Whereas, in our study, it could be that men who objectively would be high priority candidates for PrEP do not perceive themselves as appropriate for PrEP, or perceived that PrEP was appropriate for someone whose HIV acquisition risk was higher than theirs.…”

“…Knowledge and familiarity of PrEP among gay, bisexual, and GBM is increasing, but far fewer are currently using PrEP (Parsons, Rendina, Whitfield, & Grov, 2016; Peabody, 2016). A New York City (NYC) study found that knowledge of PrEP had increased significantly between 2011 and 2014, though willingness to start PrEP did not (Grov, Rendina, Whitfield, Ventuneac, & Parsons, 2016). Nevertheless, some data suggest that uptake may be gaining momentum—the number of New York State Medicaid beneficiaries receiving PrEP increased from 303 in 2013–2014 to 1330 in 2014–2015 (a 438% increase) (CDC, 2015; Poz.com, 2016).…”