Poppers and PrEP: Use of Pre-exposure Prophylaxis Among Men Who Have Sex with Men Who Use Inhaled Nitrites

Abstract

Men who have sex with men (MSM) commonly use inhaled nitrites, or poppers, though their use is a risk factor HIV seroconversion. Pre-exposure prophylaxis, or PrEP, is effective for HIV prevention, but is not widely used, and little is known regarding PrEP use and acceptability among MSM who use inhaled nitrites. We surveyed 580 MSM in Paris, France in 2016 about popper use, sexual behaviors including condomless anal intercourse (CAI), serosorting, and sexual positioning, PrEP use, PrEP candidacy, and interest in alternate PrEP delivery modalities. We included 444 HIV negative participants for the current study. 46.2% reported popper use in the prior 3 months. Using multivariate adjusted logistic regression, we found that popper users were more likely than non-users to consider themselves candidates for PrEP [adjusted relative risk ratio (aRRR) = 2.73; 95% CI 1.54-4.83], but they were not more likely to be current (aRRR = 1.54; 95% CI 0.71-3.33) or past (aRRR = 1.37; 95% CI 0.44-4.28) PrEP users. Mediation analyses indicated that increased CAI and serosorting partly explained the relationship between popper use and PrEP candidacy. There was considerable interest in alternate proposed PrEP delivery modalities, particularly long-acting injectable PrEP [adjusted risk ratio (aRR) = 1.43; 95% CI 1.15-1.79].

Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe

“…A behavior common among MSM relates to the significant proportion of these individuals who use inhaled nitrites, or poppers, to enhance sexual intercourse. A survey was conducted in 2016 in 580 MSM living in Paris (France) regarding the use of poppers, condomless sexual anal intercourse, serosorting, sexual positioning, use of PrEP, PrEP candidacy and even interest in different possibilities for PrEP delivery ( 62 ). The study showed that popper users were more likely to consider themselves suitable candidates for PrEP, while showing that they were most probably not current or past users of PrEP ( 62 ).…”

“…A survey was conducted in 2016 in 580 MSM living in Paris (France) regarding the use of poppers, condomless sexual anal intercourse, serosorting, sexual positioning, use of PrEP, PrEP candidacy and even interest in different possibilities for PrEP delivery ( 62 ). The study showed that popper users were more likely to consider themselves suitable candidates for PrEP, while showing that they were most probably not current or past users of PrEP ( 62 ). Explanations for the belief that these individuals would be suitable candidates and actively considered PrEP were related to increased serosorting and condomless anal sexual intercourse reported by these participants ( 62 ).…”

“…The study showed that popper users were more likely to consider themselves suitable candidates for PrEP, while showing that they were most probably not current or past users of PrEP ( 62 ). Explanations for the belief that these individuals would be suitable candidates and actively considered PrEP were related to increased serosorting and condomless anal sexual intercourse reported by these participants ( 62 ). Also emerging from this survey is the enormous interest demonstrated in alternative PrEP delivery options, namely, long-acting injectable versions of PrEP ( 62 ).…”

Harmless? A hierarchical analysis of poppers use correlates among young gay and bisexual men

“…Poppers were originally intended to aid in the treatment of heart conditions, particularly angina, but became increasingly popular due to other effects. Depending on expectancies of poppers use in individuals and the context in which these are used, effects may include mild euphoria and a heightened state of sexual arousal , as well as relaxant effects on certain muscles including the sphincter and vagina . Poppers are most commonly used before or during sexual activity but have always been used outside of sexual contexts, and an increase in non‐sexual recreational use among young people has been registered in different jurisdictions .…”

Social and Behavioral Correlates of Sexually Transmitted Infections among Men who Have Sex with Men who Use Alcohol in the San Francisco Bay Area

“…condomless anal intercourse (CAI) and multiple sexual partnerships (Carey et al, 2009;Hambrick et al, 2018;Sewell et al, 2017). Additionally, a systematic review of different substances used in nightlife settings ("club drugs") documented their associations with STI incidence (Drumright et al, 2006).…”