Human Immunodeficiency Virus Preexposure Prophylaxis Knowledge, Attitudes and Perceptions of Sexual Health Risk in an Age of Sexually Transmitted Infection Antimicrobial Resistance

Lorenc, Ava; Nicholls, Jane; Kesten, Joanna M; MacGregor, Louis; Speare, Nathan; Harryman, Lindsey; Turner, Katherine Mary Elizabeth; Horner, Patrick J; Horwood, Jeremy

doi:10.1097/olq.0000000000001384

Cited by 6 publications

(17 citation statements)

References 23 publications

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“…Our qualitative study indicates that MSM may have a good understanding of PrEP and why it is of use in key populations such as MSM. For our participants, PrEP was valued for its impact on reducing HIV as well as reducing anxiety over HIV acquisition; a finding found in several previous studies [19][20][21]. In our study, MSM also had a reasonable knowledge of many STIs, with HIV, gonorrhoea and chlamydia being most familiar to participants.…”

Section: Discussionsupporting

confidence: 60%

“…While some participants were aware of AMR STIs, this was not viewed as a current and immediate risk but felt that resistant STIs would need to be more prevalent and untreatable before they would consider changing their behaviour. The belief that AMR STIs were not a personal risk was also identified in qualitative work conducted in Bristol among PrEP users [ 19 ]. This suggests that the problem of STI AMR would need to become a personal, direct, and serious threat before condoms are used alongside PrEP.…”

Section: Discussionmentioning

confidence: 99%

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The relationship between HIV pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance: a qualitative interview study of men who have sex with men

et al. 2022

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Background HIV pre-exposure prophylaxis (PrEP) is a medication that prevents the acquisition of HIV. It has been targeted towards men who have sex with men (MSM). Since its introduction there have been concerns raised around changes in sexual behaviour such as increased condomless anal intercourse (CAI), leading to an elevation in sexually transmitted infections (STIs). With antimicrobial resistant strains of STIs rising, there are concerns that PrEP may be contributing to this growth. This study aims to understand how MSM conceptualise the relationship between PrEP, STIs and antimicrobial resistance (AMR). Methods Twenty semi-structured interviews were conducted online using Zoom. Participants include a mix of PrEP related experiences (never used, currently use, previously used). Reflexive thematic analysis was undertaken by the lead author with 10% of transcripts double coded. Results MSM in Wales have positive views and a good knowledge of PrEP and awareness of bacterial STIs. PrEP is perceived by many to lead to a reduction in condom use and increase in STIs but reported condom use behaviours presented to be stable in terms of PrEP initiation. PrEP use is influenced by increased concern for HIV and minimal concern for bacterial STIs. Awareness of AMR STIs was lacking. Conclusions There is a belief that PrEP use will lead to an increase in STI rates through reduced condom use, despite reported behaviours often being stable in relation to PrEP initiation, PrEP stigma may be influencing this dichotomy. Concern and awareness for resistant STIs is low, with little association to PrEP.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

The relationship between HIV pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance: a qualitative interview study of men who have sex with men

et al. 2022

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“…Lack of PrEP awareness was the second most frequently reported barrier, tied with lack of PrEP willingness and lack of access to a PrEP provider ( n = 16) [25, 27, 29–35, 37, 44, 56, 57, 59, 61, 63]. Although awareness was high among MSM (81%–100%) [25, 27, 33, 35, 37, 44, 56, 57], it was much lower among ethnic minorities (13%–54%) [29, 30, 34, 56, 57] and trans‐identifying people (16%–66%) [61] [56].…”

Section: Resultsmentioning

confidence: 99%

“…Lack of PrEP knowledge was the most studied barrier (Figure 3): it was investigated in 19 of the studies [10, 24, 25, 27, 33–35, 41, 44, 46, 48, 51, 53, 56, 58, 59, 61, 62, 65]. One study found that 44% of survey respondents listed lack of PrEP knowledge as a direct barrier to PrEP use [56].…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to HIV Pre‐Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum

et al. 2023

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Objectives HIV pre‐exposure prophylaxis (PrEP) delivery in the UK is inequitable; over 95% of PrEP users were men who have sex with men (MSM) despite making up less than 50% of new HIV diagnoses. We conducted a systematic review to identify modifiable barriers and facilitators to PrEP delivery in the UK among underserved populations. Methods We searched bibliographic/conference databases using the terms HIV, PrEP, barriers, facilitators, underserved populations, and UK. Modifiable factors were mapped along the PrEP Care Continuum (PCC) to identify targets for interventions. Results In total, 44 studies were eligible: 29 quantitative, 12 qualitative and three mixed‐methods studies. Over half (n = 24 [54.5%]) exclusively recruited MSM, whereas 11 were in mixed populations (all included MSM as a sub‐population) and the other nine were in other underserved populations (gender and ethnicity minorities, women, and people who inject drugs). Of the 15 modifiable factors identified, two‐thirds were at the PrEP contemplation and PrEParation steps of the PCC. The most reported barriers were lack of PrEP awareness (n = 16), knowledge (n = 19), willingness (n = 16), and access to a PrEP provider (n = 16), whereas the more reported facilitators were prior HIV testing (n = 8), agency and self‐care (n = 8). All but three identified factors were at the patient rather than provider or structural level. Conclusions This review highlights that the bulk of the scientific literature focuses on MSM and on patient‐level factors. Future research needs to ensure underserved populations are included and prioritized (e.g. ethnicity and gender minorities, people who inject drugs) and provider and structural factors are investigated.

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“…Current qualitative studies have found that the risk of STI AMR is not perceived as an immediate threat by certain MSM. 26 However, we do not yet know to what extent this is attributable to all MSM and whether targeted awareness campaigns may change such perceptions. Nevertheless, the high prevalence of combined resistance to fluoroquinolones and macrolides in those with recurrent STIs suggests that a period of untreatable STIs is at hand.…”

Section: Discussionmentioning

confidence: 98%

Worryingly high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium among men who have sex with men with recurrent sexually transmitted infections

et al. 2022

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Background Men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP) recurrently infected with STIs are playing a pivotal role in contemporary Sexually transmitted infections (STI) epidemics. Our aim was to assess whether these individuals had more Mycoplasma genitalium ( M. genitalium) infections and more resistance to macrolides and fluoroquinolones of M. genitalium compared to those who were not recurrently infected with STIs. Methods The study was performed on 179 Belgian MSM PrEP users that were followed up for 18 months. STIs including M. genitalium were detected quarterly. Detection of resistance-associated mutations (RAMs) to macrolides and fluoroquinolones was performed via Sanger sequencing of the 23S rRNA gene and parC gene (conferring mutations at position 83/87 in ParC). Differences in M. genitalium positivity rate and presence of RAMs between both groups were assessed using mixed-effects logistic regression. Results A total of 91 new M. genitalium infections were detected among 70 participants. MSM experiencing recurrent STIs have significantly more M. genitalium infections compared to those without (11.7% vs. 4.7% OR: 2.69). Importantly, the prevalence of RAMs to macrolides (95.2% vs. 77.4%) and fluoroquinolones (35.7% vs. 12.9%) was much higher among individuals with recurrent STIs. The difference was only statistically significant for macrolides (OR 5.83, p = .036). Conclusions MSM recurrently infected with STIs play a central role in the emergence of antimicrobial resistance in M. genitalium. The use of macrolides and fluoroquinolones should preferably be minimized in this population in order to avoid further emergence of multi-resistant M. genitalium.

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Human Immunodeficiency Virus Preexposure Prophylaxis Knowledge, Attitudes and Perceptions of Sexual Health Risk in an Age of Sexually Transmitted Infection Antimicrobial Resistance

Cited by 6 publications

References 23 publications

The relationship between HIV pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance: a qualitative interview study of men who have sex with men

The relationship between HIV pre-exposure prophylaxis, sexually transmitted infections, and antimicrobial resistance: a qualitative interview study of men who have sex with men

Barriers and facilitators to HIV Pre‐Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum

Worryingly high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium among men who have sex with men with recurrent sexually transmitted infections

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