Perceived Versus Calculated HIV Risk: Implications for Pre-exposure Prophylaxis Uptake in a Randomized Trial of Men Who Have Sex With Men

Abstract

Background: Inaccurate HIV risk perception by men who have sex with men (MSM) is a barrier to HIV prevention. Providing information about objective HIV risk could improve preexposure prophylaxis (PrEP) uptake. Methods: PrEP Accessibility Research & Evaluation 2 (PrEPARE2) was a randomized controlled trial of MSM to determine if an objective risk score affects future PrEP uptake. Participants completed a baseline survey to assess demographics, risk behaviors and HIV selfperceived risk (SPR). The survey generated a calculated HIV risk score (CalcR), estimating HIV risk based on reported condomless anal intercourse and sexually transmitted infections, and was provided to individuals in the intervention arm. Participants were contacted 8 weeks later to determine if they initiated PrEP. Results: Of 171 participants (median age 32; 37% Hispanic or Non-Hispanic Black; median 5 sexual partners in past 6 months), 81% had heard of PrEP, and 57% thought they were good PrEP candidates. SPR had poor agreement with CalcR (kappa=0.176) with 38% underestimating their HIV risk. At week 8, only 14 of 135 participants had initiated PrEP with no difference between arms (CalcR 11%, control 10%, p>0.99). The most common reason for not starting PrEP was low HIV risk perception. There was a relative decrease in SPR over time (p=0.06) but no difference between arms (p=0.29). Conclusion: Providing an objective HIV risk score alone did not increase PrEP uptake. HIV testing performed at testing sites may be a crucial time to correct misperceptions about risk and initiate same-day PrEP given enthusiasm for PrEP on testing day to facilitate greater uptake.

Slow Uptake of PrEP: Behavioral Predictors and the Influence of Price on PrEP Uptake Among MSM with a High Interest in PrEP

“…To increase uptake, it is therefore important to identify facilitators and barriers of PrEP use. While earlier studies investigated behavioral and psychological factors of PrEP uptake, such as sexual risk behaviors, perceived HIV risk, and stigma [ 14 – 17 ], the influence of actual price changes on PrEP use has not been fully investigated, especially not in contexts where universal health care coverage of PrEP is not (yet) available.…”

PrEP Interest Among Men Who Have Sex with Men in the Netherlands: Covariates and Differences Across Samples

“…Despite the increased accessibility of PrEP, PrEP uptake has remained low, even among men who have sex with men (MSM) who are primary candidates for PrEP (Parsons et al, 2017). MSM may underestimate their risk of getting HIV, and may therefore see themselves as not requiring PrEP (Blumenthal et al, 2019;Parsons et al, 2017). Other barriers for PrEP uptake may include medical mistrust and anticipated stigma from sex partners (Biello et al, 2017;Cahill et al, 2017;Golub, 2018).…”

Recommendations for Intervention Content to Enhance HIV Pre-Exposure Prophylaxis Uptake among Men Who have Sex with Men Receiving Care at Sexually Transmitted Disease Clinics

“…To raise awareness about HIV acquisition risks, participants recommended a subjective HIV risk scoring instrument that could easily be self-administered during the intake process. 24 This tool could easily be self-administered by patients in busy STD clinics, and then presented to health care providers to shorten intervention time with each client. This might help mitigate inaccurate self-perceived HIV acquisition risks, which are major barriers to PrEP uptake.…”