HIV Prevention Responsibility Beliefs Among Men Who Have Sex With Men in the PrEP Era

Abstract

Background: Beliefs regarding responsibility for preventing HIV transmission may differ between individuals and their sexual partners. We assessed HIV prevention responsibility beliefs among men who have sex with men (MSM) participating in the 2017 National HIV Behavioral Surveillance survey.Methods: MSM were recruited using time-location sampling at clubs, bars, and street locations in San Francisco. HIV prevention responsibility beliefs were assessed on a four-point scale (1 = strongly disagree to 4 = strongly agree). Associations were assessed using generalizing estimating equations to adjust for behaviors within multiple partnerships.Results: A total of 316 HIV-negative men and 76 HIV-positive men reported on 1336 partnerships. HIV-negative compared with HIV-positive men had higher endorsement of mutual responsibility (mean 3.7 vs. 3.5; P , 0.01). Both groups had similar levels of endorsing responsibility on the HIV-negative or HIV-positive partner. HIV-positive men endorsing equal responsibility were more likely to know their partner's HIV status (P , 0.01) and less likely to have serodiscordant condomless anal intercourse (CAI) (P , 0.01) than men who did not endorse equal responsibility. HIV-negative men in partnerships with pre-exposure prophylaxis (PrEP) use were more likely to know their partner's HIV status (P = 0.02) and have serodiscordant CAI (P = 0.04) than men not in partnerships with PrEP use.Conclusions: HIV-negative and HIV-positive men accept responsibility for preventing HIV. The finding that HIV-negative men in partnerships with PrEP use who engage in serodiscordant CAI is concerning because they are still at risk for other sexually transmitted infections, which are presently at elevated levels in San Francisco and other US cities.

Characteristics of HIV pre-exposure prophylaxis users at first PrEP counselling visit: the CSL-PrEP cohort

“…Reassuringly, we observed a significant rising trend in the number of PrEP counselling visits conducted at our centre and no boundaries in PrEP prescription imposed by out of range renal or hepatic blood values, which suggest that, over time, access to PrEP is becoming easier, also thanks to community empowerment. 19 …”

“…Reassuringly, we observed a significant rising trend in the number of PrEP counselling visits conducted at our centre and no boundaries in PrEP prescription imposed by out of range renal or hepatic blood values, which suggest that, over time, access to PrEP is becoming easier, also thanks to community empowerment. 19 Event-based and daily-based PrEP regimens have demonstrated to have similar efficacy rates in preventing HIV infection. 2 Individuals choose the regimen mostly depending on the characteristics of their sexual behaviours.…”

“…In Europe, Italy and Milan, there is still an ‘unbalanced’ access to PrEP when compared with all key populations who might theoretically benefit from PrEP: for instance, it has been estimated that around 500 million MSM in Europe cannot access PrEP despite being very likely to use it (‘PrEP gap’) 18. In Italy, access to PrEP can be considered less challenging, depending on regional variabilities, as often the HIV and STI screenings required for PrEP prescription and during follow-up are free of charge; though, being PrEP not reimbursed by the National Health Service, access to PrEP might be particularly challenging for the youngest 8 19. All in all, currently, there is still a lack of access to PrEP in Italy; in fact, findings from our cohort showed that most PrEP users were high educated, Caucasian adults, without inclusion of transgender individuals and few foreigners.…”