Factors associated with intention to take non-occupational HIV post-exposure prophylaxis among Thai men who have sex with men

Abstract

Background Men who have sex with men (MSM) are disproportionately infected with HIV in Thailand. Factors affecting their intention to take non-occupational HIV post-exposure prophylaxis (nPEP) are not well understood. This study sought to determine factors associated with an intention to take nPEP in this population. Method This is a two-phase mixed-method study. Phase I was a cross-sectional survey of intention to take nPEP in 450 MSM attending for HIV testing, using a self-administered questionnaire. Phase II was a prospective descriptive study, using an in-depth interview among 40 MSM who had been exposed to HIV in the past 72 hours. Multiple logistic regression was used to evaluate factors relating to the intention to use nPEP. Results Among 450 MSM seeking HIV testing in Bangkok, 7% had ever taken nPEP. Only 40% expressed an intention to take it to prevent HIV acquisition, despite the fact that they were at high risk as evidenced by an 18.9% prevalence of HIV-positive status. Factors associated with an intention to take nPEP were awareness about nPEP, HIV knowledge, mode of sexual intercourse and circumcision. Among 40 MSM who were eligible for and offered nPEP, 39 agreed to take it, and all but one completed the 4-week course. Condom use increased and all 32 individuals who could be contacted tested HIV negative after nPEP. Conclusion A high HIV prevalence was found in MSM testing for HIV in this study. However, fewer than half of the participants expressed the intention to take nPEP if they were at risk for HIV infection. Efforts to create nPEP awareness and improve HIV knowledge in MSM are crucial to the successful implementation of nPEP as part of a combination package for HIV prevention in this high-risk population.

Implementation of HIV non-occupational post-exposure prophylaxis for men who have sex with men in 2 cities of Southwestern China

“…One nPEP recipient was found subsequently seroconverted to HIV at 3-month after exposure due to ongoing high-risk behaviors, not ascribed as nPEP failure, as observed in other similar studies. [ 51 , 57 ] There is something noticeable that 46 participants’ source contact had been confirmed as HIV positive, and 44 nPEP users were tested as negative during the repeating HIV serology, except for 2 not complying with the follow-up appointment. All again testify that nPEP, one of several biomedical HIV prevention strategies, is truly effective in real-world settings.…”

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

“…Several studies checked whether self-reported knowledge about PEP was accurate or evaluated PEP knowledge in MSM. Those MSM who were aware of PEP had adequate knowledge about PEP; however, less than half of them correctly answered that PEP needs to be taken for 28 days (30,34). Among 94 MSM who had heard of PEP, 11% were concerned about side effects; most (68%) felt they would know how to get PEP, and nearly two-thirds anticipated that they would not be able to afford it (8).…”

“…Individual factors Concern about side effects (8) Having been involved in high-risk sexual intercourse (37,39) Lack of PEP information (11,34) Using methamphetamine (11) Having an adequate knowledge about PEP Knowledge where to get PEP (30,36,43)…”

“…Being circumcised (30) Social factors Being refused housing Experiencing abusive language (36) (36) Being in a relationship (11) Structural factors Expense of PEP (8,36) from 4.18% in 2006 to 30.01% in 2016 (11). Subgroup analysis revealed that PEP use in developing countries was significantly higher than that in developed countries (Q statistic = 96.77; p < 0.001): eight studies from developed countries found that the point estimate of proportions of MSM who previously used PEP was 5.4% (95% CI: 4.8∼6.1), and five studies from developing countries found the point estimate was 13.2% (95% CI: 11.5∼15).…”

Examining potential effects of non-occupational post-exposure prophylaxis (nPEP) on sexual behaviors of Chinese men who have sex with men: a cross-sectional study

“…We hypothesize that nPEP use might influence nPEP knowledge, and it might influence anticipated individual and population behavioral changes and discrepancy directly and indirectly. People generally first learn about HIV, and then nPEP [ 23 ], and HIV and nPEP knowledge were associated with an intention to use nPEP [ 24 ]. In this regard, we hypothesize that HIV knowledge might have an effect on nPEP knowledge, and it might influence anticipated individual and population behavioral changes and discrepancy directly and indirectly.…”