PrEP users among Lisbon MSM Cohort participants – A first look after PrEP implementation in Portugal

Abstract

Background Pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine has shown to be effective in preventing HIV among high-risk HIV-negative men who have sex with men (MSM). Portugal made PrEP available in February 2018, but few MSM reported PrEP use before. We aimed to compare the sociodemographic characteristics of MSM using PrEP and those knowing PrEP but not using and to compare MSM who started PrEP before and after its implementation in Portugal. Methods We performed a cross-sectional analysis, using Lisbon MSM Cohort data - an open prospective cohort of HIV-negative MSM testing at a community-based center in Lisbon - regarding the first time PrEP use was reported. Data from March 2015 to April 2019 was used. In this period 2142 MSM participated in the cohort and reported to know PrEP of whom 160 (7.5%) reported to use it. 83 PrEP-users answered a subset of questions about PrEP. Comparisons were performed using t-test, Chi-square or Fisher’s exact test. Results Comparing with non-users, PrEP users were significantly older (Mean: 35.7, SD 9.4 vs. 30.8, SD 9.2, p < 0.001), had more frequently a Master or PhD degree (37.2% vs. 27.4%, p = 0.017), and were more frequently born in a foreign country (42.2% vs. 31.8%, p < 0.001). Groups were similar in terms sexual orientation. Among the 83 PrEP users answering more questions about PrEP, 28 (33.7%) reported to have ordered their PrEP medication online, 24 (28.9%) obtained it in a medical appointment in Portugal, 15 (18.1%) in a foreign country, 4 in a clinical trial or demonstration project. Of all PrEP users, 30 (19.4%) started PrEP only after February 2018, and no sociodemographic differences were found comparing with those who started before. Conclusions MSM reporting PrEP use were more educated, older and more frequently born in a foreign country than non-PrEP users. MSM starting PrEP before and after February 2018 were similar, which may indicate that making PrEP available did not yet reach a more diverse group of MSM. Key messages MSM reporting PrEP use were more educated, older and more frequently born in a foreign country than non-PrEP users. MSM starting PrEP before and after February 2018 were similar, which may indicate that making PrEP available did not yet reach a more diverse group of MSM.

Underlying factors related to HIV/AIDS prevention: investigating the willingness to take pre-exposure prophylaxis among men-who-have-sex-with-men in Germany

“…Previous studies consistently found that younger respondents displayed greater willingness to take PrEP [ 61 , 64 – 66 ]. However, mixed results have been reported in studies measuring age in association with actual use of PrEP: Several studies reported that PrEP users were more likely to be of older age [ 67 , 68 ] while other studies reported a greater likelihood of usage among the younger MSM [ 69 , 70 ]. For its research purpose, which investigates the willingness to take PrEP, the current study will examine age in accordance with previous findings indicating higher willingness to take PrEP among younger MSM.…”

“…Some studies reported a lack of significant association [ 32 , 33 ], others showed that MSM possessing less than a high school degree display greater intention and likelihood to use PrEP [ 42 , 61 , 64 ] than those who those who achieved a more higher level of education [ 70 , 71 ]. Yet, when it comes to actual PrEP uptake, the association between level of education and PrEP use seems to be reversed: having a university education was found to be associated with PrEP use [ 66 , 68 , 72 ]. The present study examined data surveyed prior to the implementation of PrEP in Germany, where access to information was already available, but experience was possible only through informal resources other than the healthcare system; therefore, we build our hypothesis on previous research on willingness and not actual PrEP uptake.…”

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

“…Implementation of PrEP free of charge through the national health systems of these two countries began in 2017, with extensive expansion in later years [ 18 ], although few studies have evaluated the success of its implementation [ 27 , 32 , 33 , 34 ] and no survey has focused on studying the population of both countries together, much less comparing them [ 32 , 33 , 34 , 35 ]. Questions still remain whether PrEP can be translated to a successful public health intervention, leading to a decrease in the population-level incidence of HIV, if it is treated only as a local policy, without countries considering the dynamics of the flows of migration and information between countries, for example [ 36 ].…”

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants

“…Nevertheless, studies conducted with MSM have revealed difficulties in accessing PrEP in Portugal, particularly regarding the ideal way to enter the system, the waiting time for the first consultation, or even approval for treatment. This has led, for example, to the purchase of these drugs online at high prices and their use without proper monitoring, something that may not be possible for immigrants (10)(11)(12).…”