Factors Associated With Willingness to Use Daily Antibiotics as Sexually Transmitted Infection Prophylaxis Among HIV Preexposure Prophylaxis–Experienced Gay and Bisexual Men in Australia

Abstract

Background: Gay and bisexual men (GBM) who use HIV preexposure prophylaxis (HIV-PrEP) have high rates of bacterial sexually transmitted infections (STIs). The use of daily antibiotics as STI preexposure prophylaxis (STI-PrEP) may be appealing to GBM who are using or have previously used HIV-PrEP (HIV-PrEP-experienced) for the prevention of bacterial STIs. Methods:We examined willingness to use daily STI-PrEP among a cross-sectional sample of HIV-PrEP-experienced GBM in Australia who participated in an observational online cohort study from August 2018 to March 2020. Factors associated with willingness to use daily STI-PrEP were determined using bivariate and multivariate logistic regression.Results: Of the 1347 participants, half (54.3%) were willing to use daily STI-PrEP. Factors independently associated with greater willingness to use daily STI-PrEP included having >10 sexual partners in the last 6 months, using methamphetamine in the last 6 months, being more conscious about avoiding STIs, having a greater number of STIs since commencing HIV-PrEP, being willing to take HIV-PrEP for as long as they were at risk of acquiring HIV, and only using condoms when a sexual partner requested them.Conversely, factors associated with less willingness to use daily STI-PrEP included being university educated, using nondaily dosing regimens of HIV-PrEP, preferring event-driven HIV-PrEP, and being concerned about long-term HIV-PrEP adverse effects. Conclusions:Sexually transmitted infection PrEP is likely to be appealing to many HIV-PrEP-experienced GBM, especially those who engage in activities associated with a higher risk of STI transmission. However, they are less likely to be willing to use STI-PrEP unless it aligns with their HIV-PrEP dosing regimen, suggesting that research into the safety and efficacy of alternative STI prophylaxis dosing options should be prioritized.

Doxycycline prophylaxis for bacterial sexually transmitted infections: evaluating effectiveness, risks, and challenges

“…The effectiveness of public health strategies among MSM, such as bacterial STI prevention using doxycycline prophylaxis, depends on community and healthcare provider acceptance for success. Several studies, primarily based on surveys or interviews, indicate that the use of doxycycline for preventing bacterial STIs is generally accepted among MSM [33][34][35][36] .…”

“…This percentage notably increased to 75.8% (95% CI: 74.0-77.6%) if chemoprophylaxis was shown to help reduce infections within this community 29 . Also in Australia, another online survey on 1347 MSM identified 54.3% willing to use DoxyPrep and linked willingness to participants with high number of sexual partners (> 10), recent methamphetamine use, being conscious about avoiding STIs, having a history of more STIs since starting HIV PrEP, and using condoms only on a partner's request 33 . In China, an online survey on 725 participants verified that willingness to use syphilis chemoprophylaxis was greater among those without a history of prior doxycycline use (p = 0.009).…”

Implementation of Sexually Transmitted Infection Chemoprophylaxis in the United States

“…In the March issue, Arapali et al (https://journals.lww.com/stdjournal/Fulltext/2023/03000/Factors_Associated_With_Willingness_to_Use_Daily.4.aspx) describe the willingness of HIV PrEP-experienced MSM to use STI PrEP in Australia 4 . The study found that just over half (54%) of an online cohort of MSM reported willingness to use daily STI PrEP.…”