Preexposure Antiretroviral Prophylaxis Attitudes in High-Risk Boston Area Men Who Report Having Sex With Men: Limited Knowledge and Experience but Potential for Increased Utilization After Education

Abstract

Background Pre-exposure prophylaxis (PrEP) could protect individuals engaging in repeated high-risk behaviors from HIV infection. Understanding the demographic and behavioral predictors of intent to use PrEP may prove useful to identify clinical trial participants. Methods In 2007, 227 HIV-uninfected MSM recruited through modified respondent-driven sampling completed an interviewer-administered survey assessing prior PrEP use and awareness, future intent to use PrEP, demographics, sexual risk, psychosocial variables, and drug/alcohol use. Bivariate and multivariable logistic regression procedures examined predictors of intention to use PrEP. Results Mean age of participants was 41 (SD=9.1); 54% were non-white. One participant reported prior off-label PrEP use (medication obtained from his HIV-infected brother). Nineteen percent had previously heard of PrEP, while 74% reported intent to use PrEP if available after being educated about its potential. In multivariable analysis controlling for age and race/ethnicity, significant predictors of intent to use PrEP included: less education (OR=7.7; p=0.04), moderate income (OR=13.0; p=0.04), no perceived side effects from taking PrEP (OR=3.5; p=0.001), and not having to pay for PrEP (OR=4.2; p=0.05). Discussion Many New England MSM indicated an interest in using PrEP after learning about its potential, particularly if they could obtain PrEP at no expense and if PrEP had no side effects. Less educated MSM and those who knew less about PrEP and antiretroviral therapy (ART) before entering the study were more open to using ART for prevention once they had received some information suggesting its potential value. Findings suggest careful educational messages are necessary to ensure appropriate PrEP use if clinical trials reveal partial efficacy.

Participant Experiences and Facilitators and Barriers to Pill Use Among Men Who Have Sex with Men in the iPrEx Pre-Exposure Prophylaxis Trial in San Francisco

“…Participants reported low levels of knowledge and discussion about PrEP in the community, which may have hindered their ability to speak to others about their PrEP use; this observation is consistent with others made at the time, regarding community knowledge of PrEP. [45][46][47] A few participants reported concerns about being seen with pills that may be associated with HIV, although stigma seems to be a much greater barrier to adherence in other studies and at other sites. 25,27,48 Future strategies to support MSM in discussing their participation in PrEP studies/implementation programs and their overall pill taking could include peer support interventions.…”

Barriers to Access and Adoption of Pre-Exposure Prophylaxis for the Prevention of HIV Among Men Who Have Sex With Men (MSM) in a Relatively Rural State

“…Congruent with other studies, participants indicated that many persons who would benefit from PrEP report interest in it (Krakower et al, 2012;Mimiaga, Case, Johnson, Safren, & Mayer, 2009;Mustanski, Johnson, Garofalo, Ryan, & Birkett, 2013) but are unware of how the medication works and how it is part of an overall HIV prevention strategy (Knight et al, 2016). PrEP awareness, or lack thereof, among participants is representative of an underdeveloped sexuality education system to serve MSM and other sexual minorities in relatively rural states (Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010;Poon & Saewyc, 2009).…”

Predictors of Identifying as a Barebacker among High-Risk New England HIV Seronegative Men Who Have Sex with Men

“…Findings show significant associations of barebacking identity to serodiscordant unprotected insertive anal sex and suggest that encouraging harm-reduction strategies, in particular strategic positioning, may be an appropriate intervention technique to employ with self-identified barebacking MSM who may not respond to the prevention goal of completely eliminating unsafe sex. 12 Moreover, preceding studies have documented willingness to use rectal microbicides, 37,38 and postexposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP) [39][40][41] among HIV seronegative MSM. Recent research has begun to explore the acceptability of alternative HIV biomedical products (microbicides, vaccines, PEP, and PrEP) with MSM who engage in unsafe sex.…”