PrEP use and unmet PrEP-need among men who have sex with men in London prior to the implementation of a national PrEP programme, a cross-sectional study from June to August 2019

Abstract

Background Access to prevention options, including HIV pre-exposure prophylaxis (PrEP), remains a public health priority for gay, bisexual, and other men who have sex with men (MSM), especially in London. We describe PrEP use in a London community sample of MSM before the introduction of a national PrEP programme in October 2020. Methods From June–August 2019, MSM aged ≥ 18 recruited from London commercial venues were asked to self-complete a sexual health questionnaire and provide an oral fluid sample for anonymous HIV antibody testing. Descriptive analyses of demographic characteristics, service engagement and outcomes, as well as sexual risk and prevention behaviours were examined in the survey population and in those reporting current PrEP use. We performed sequential, multivariate analyses examining current PrEP use in MSM of self-perceived HIV-negative/unknown status with identified PrEP-need defined as the report of condomless anal sex (CAS) in the last three months, or the report of CAS (in the last year) with an HIV-positive/unknown status partner not known to be on HIV treatment, in reflection of UK PrEP guidelines. Results One thousand five hundred and thirty-fifth questionnaires were completed across 34 venues, where 1408 were analysed. One in five MSM of self-perceived HIV-negative/unknown status reported current PrEP use (19.7%, 242/1230). In men with PrEP-need, 68.2% (431/632) did not report current use. Current PrEP use was associated with age (aOR: 3.52, 95% CI: 1.76–7.02 in men aged 40–44 vs men aged 18–25) and education (aOR: 1.72, 95% CI: 1.01–2.92 in men with ≥ 2 years/still full-time vs no/ < 2 years of education since age 16). Conclusion Among MSM in London, PrEP use is high but there is indication of unmet PrEP-need in men of younger age and lower levels of post-16 education. National programme monitoring and evaluation will require continued community monitoring to guide interventions ensuring equitable PrEP access and uptake in those who could most benefit from PrEP.

Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022

“…That finding could reflect SHS access barriers because only 38% of vaccine-eligible participants who were not offered a vaccine had visited an SHS since August 2022. However, that group might have less regular engagement with SHS ( 31 , 32 ). Vaccine provision and service-level constraints resulting from increased mpox infection control measures and service reconfigurations that included online triage could have limited face-to-face vaccine offers and subsequent uptake ( 33 , 34 ).…”

Impact of national commissioning of pre-exposure prophylaxis (PrEP) on equity of access in England: a PrEP-to-need ratio investigation

“…Another limitation is that PrEP Impact trial data underestimate PrEP use (and, therefore, an underestimate of the PnR) over the duration of the trial. This is because demand from attendees outpaced the number of Impact places available, resulting in private purchase of PrEP, 25 and, therefore, would not be included in the precommissioning numbers presented here. This is a problem most likely affecting MSM estimates, as they made the bulk of self-sourcing PrEP users, 26 which would imply an underestimation of the equity gaps with other populations during Impact.…”

Mpox diagnosis history, behavioural risk modification, and vaccination uptake in gay, bisexual, and other men who have sex with men in the UK: findings from a large, online community cross-sectional survey (RiiSH-Mpox) undertaken November/December 2022

“…Most mpox vaccinated GBMSM met proxy eligibility criteria, however a third of those considered vaccine eligible did not report mpox vaccination, most of whom did not receive a vaccine offer. Findings could reflect SHS access barriers as only a third of those vaccine eligible and not offered a vaccine had visited a SHS since August 2022; in contrast, this may add to indications that some GBMSM do not regularly engage with SHS (29,30). Vaccine provision and service-level constraints as a result of increased infection control measures needed for mpox management, as well as service reconfigurations, that included online triage, could have limited face-to-face offer and subsequent uptake (31,32).…”