Pre-Exposure Prophylaxis Counseling in a Community Sexual Health Clinic for Men Who Have Sex with Men in Lisbon, Portugal

Abstract

Introduction: Pre-exposure prophylaxis is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals. Recognizing the increasing use of informal pre-exposure prophylaxis in Portugal, CheckpointLX, a community clinic targeted to men who have sex with men in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This study aims to characterize pre-exposure prophylaxis users attending CheckpointLX before formal pre-exposure prophylaxis introduction in Portugal, and those who were referred to pre-exposure prophylaxis in the National Health Service following formal approval of pre-exposure prophylaxis.Material and Methods: Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database. Medical care followed the European AIDS Clinical Society recommendations for pre-exposure prophylaxis eligibility, initiation and follow-up. For formal pre-exposure prophylaxis, the General-Directorate for Health’s Pre-exposure Prophylaxis guidelines checklist was used.Results: Until the end of May 2018, CheckpointLX had a total of 90 appointments for wild pre-exposure prophylaxis, of which 64 (71%) were first time visits. As for the 380 service users referred to the National Health Service, most were Portuguese (n = 318, 84%), and the mean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria (n = 59, 83%).Discussion: Pre-exposure prophylaxis delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration, in the scope of broader preventive sexual health care.Conclusion: Much remains to be done in Portugal to ensure that pre-exposure prophylaxis is available to those who need it the most. Offering pre-exposure prophylaxis at community clinics could be a first step.

Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries

“…Aspects linked to disclosing one’s HIV serology or not knowing the partner’s HIV serology also influenced the adherence to PrEP. This finding is reinforced by the literature [ 49 , 50 ], which points out that having a steady partner, claiming/appearing not to have STIs and having been recently tested are associated with a certain credibility that leads to waiving condom use, which can lead the participants to seek additional prevention through PrEP [ 50 , 51 , 52 ].…”

“…This may mean that the Portuguese health system is more effective than its Brazilian counterpart in identifying immigrants and incorporating them into the PrEP services. In fact, Portugal has exclusive community-based HIV testing and counseling services for MSM and immigrants, which may make a difference in the fight against the virus [ 51 , 53 ].…”

“…In view of this, certain overlaps in health vulnerabilities may emerge as a result of the weaknesses of public policies in terms of their implementation and the reduced capacity for international relations. PrEP provision programs are regulated by and integrate the health systems of each country, in accordance with the most current and important clinical and public health guidelines, in their respective spheres of action (in Brazil, they are in the charge of the Ministry of Health; in Europe, they are the responsibility of the European AIDS Clinical Society [EACS]; and worldwide, they are the responsibility of the WHO) [ 51 , 52 ].…”

“…Since its implementation, PrEP use in Portugal has been recommended for key populations, although it was only from 2018 onwards that it became available exclusively through a reference hospital for HIV infection. For the users registered in the Portuguese National Health System (Sistema Nacional de Saúde, SNS), screening, monitoring, follow-up and provision of PrEP consultations are free of charge [ 51 , 52 , 53 , 54 , 55 , 56 ].…”

Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands

“…The service should not only be affordable, but also convenient and non-judgmental. There are already several initiatives to offer these services to informal PrEP users, such as the InPrEP project in Amsterdam [67] and CheckpointLX in Lisbon, Portugal [68].…”