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

Abstract

Despite increased availability of pre-exposure prophylaxis (PrEP), PrEP uptake has remained low. To promote uptake, factors related to PrEP interest among relevant target populations warrant investigation. The aim of this study was to provide an analysis of PrEP interest among men who have sex with men (MSM) in the Netherlands, while taking study recruitment strategies into account. We recruited 154 MSM from an LGBT research panel (AmsterdamPinkPanel) and 272 MSM from convenience sampling. Both samples were part of the Flash! PrEP in Europe Survey and were compared on their PrEP interest, usage intentions, and sexual behavior. We conducted logistic regression analyses to discover variables associated with PrEP interest and intentions. Participants from the AmsterdamPinkPanel were less likely to use PrEP, had less knowledge of PrEP, and were less interested in PrEP than participants from convenience sampling. Significant covariates of PrEP interest were being single, more prior PrEP knowledge, sexual risk behaviors, such as not having used a condom during last sex and having ever used drugs in a sexual context, and not participating in the AmsterdamPinkPanel. Adding the recruitment strategy to the regression increased explained variance on top of predictors already described in the literature. Increased sexual risk behavior is related to increased PrEP interest and it helps to identify PrEP target groups. Recruitment strategies have a substantial impact on findings regarding PrEP interest and usage intentions. This study emphasizes the importance of using multiple strategies for recruiting participants to obtain a more comprehensive view of MSM's attitudes toward PrEP.

Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

“…As a biomedical intervention and part of comprehensive prevention measures, pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV-negative MSM from acquiring HIV [ 2 , 3 , 4 , 5 , 6 ]. In response, PrEP was formally introduced in Europe in 2016 and was subsequently included in the Dutch national delivery plan in September 2019 through the sexual health clinics of the Public Health Services (GGD) [ 1 , 7 , 8 , 9 ]. It is estimated that around 10,000 MSM meet the eligibility criteria for PrEP in the Netherlands [ 4 ].…”

“…To date, PrEP intention among MSM data have been mostly gathered among MSM residing in Amsterdam [ 7 , 13 , 14 , 15 ]. Cross-sectional data from these Amsterdam-based studies revealed that PrEP intention among MSM increased from 13% (high intention to use) during the initial assessment in 2013 [ 13 ] to a higher proportion of definite intention of almost 40% in 2016 [ 7 ]. To corroborate these findings, a significant increasing trend of informal PrEP uptake among Dutch MSM residing in Amsterdam from 2015 to 2017 was also observed [ 16 , 17 ].…”

“…The spatial distribution of current PrEP awareness, intention and uptake can be useful to evaluate the national programme and can help to tailor local PrEP access in order to prioritise where PrEP implementation should be further strengthened [ 11 , 18 ]. In the Netherlands, the characterisation of the residence of an individual is usually divided into the main urban area (so called “Randstad”, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam, more details in Section 2 ) and the rest of the country (ROC) [ 7 , 14 , 19 ]. However, a geo-spatial distribution of the Randstad-ROC level of PrEP awareness, intention and uptake among MSM has yet to be analysed in the Netherlands, mainly due to the limited availability of PrEP prior to its structural introduction [ 1 ].…”

“…Furthermore, it is important to jointly understand the psycho-social facilitators and hurdles of PrEP uptake together with spatial trends to unravel co-variation. So far, in the Global North, studies have mostly examined the individual-level determinants of PrEP uptake such as HIV transmission risk; prior STI diagnoses; sexualized substance use (chemsex); and socio-demographic factors, such as age, race/ethnicity, education, employment status and income [ 7 , 18 , 20 , 21 , 22 ]. In addition, urban/rural differences in PrEP awareness, intention and uptake have been investigated both quantitatively [ 23 , 24 ] and qualitatively [ 25 ], showing that MSM living in a more urbanised region have a higher chance of being aware, showing intention and using PrEP.…”

The Experience of Using Dating Applications for Sexual Hook-Ups: A Qualitative Exploration among HIV-Negative Men Who Have Sex With Men in Hong Kong

“…For example, a study in London reported that compared with older MSM, MSM who were younger were more likely to consider future PrEP use (Aghaizu et al, 2013). Having multiple sex partners or being at a higher risk of HIV/STI acquisition was also suggested as contributory attributes to finding PrEP favorable (Bil et al, 2015;Van Dijk et al, 2020). The context of dating apps in allowing prompt sexual encounters among MSM with different profiles and the rise of PrEP as a biomedical HIV prevention option compound the already complicated struggle against the use of substances during sex among MSM (Kwan & Lee, 2019;Maxwell et al, 2019).…”