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

The Fenway Institute, Fenway Community Health, Boston, MA 02119, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 02/2009; 50(1):77-83. DOI: 10.1097/QAI.0b013e31818d5a27
Source: PubMed


Preexposure 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.
In 2007, 227 HIV-uninfected men who report having sex with men (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 intent-to-use PrEP.
Mean age of participants was 41 (SD = 9.1); 54% were nonwhite. One participant reported prior off-label PrEP use (medication obtained from his HIV-infected brother). Nineteen percent had previously heard of PrEP, whereas 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 the following: less education [odds ratio (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).
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 before entering the study were more open to using antiretroviral therapy for prevention once they had received some information suggesting its potential value. Findings suggest that careful educational messages are necessary to ensure appropriate PrEP use if clinical trials reveal partial efficacy.

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    • "Reported awareness of PrEP is even lower, ranging from only 12 percent of men attending a Toronto HIV testing clinic (Leonardi, Lee, & Tan, 2011), 16 and 19 percent respectively in the California and Boston studies cited above (Liu et al., 2008; Mimiaga et al., 2009), to 22 percent of a gay sample in Washington State (Barash & Golden, 2010). Curiously, an online sample of 329 MSM in New York City found much higher awareness at 38 percent of the total (Rucinski et al., 2013) while 63 percent of men in serodiscordant couples sampled in San Francisco reported knowing of PrEP although this figure was probably inflated due to confusion between PEP and PreP (Saberi et al., 2012). "
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    ABSTRACT: This study examines awareness of and experiences with post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) among 228 men recruited in Boston, Pittsburgh, and San Juan between 12/2010 and 6/2012. All of them reported having condomless anal sex with a man in the prior year. Overall, 41% had heard of PEP, ranging from 16% in San Juan to 64% in Boston. Only 21% had heard of PrEP, ranging from 8% in San Juan to 36% in Boston. Three had used PEP, and none had used PrEP. After the methods were described to participants, interest in both was high, with intentions to use PEP and PrEP respectively at 9.1 and 7.7 (10-point scale). Increased public education is needed to raise awareness of these HIV prevention methods, especially among MSM who acknowledge potential risk behavior. It also seems likely that many such men would use these methods once they become aware of them.
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    • "The study conducted among FSWs in Xinjiang, China indicated that work condition, HIV/AIDS knowledge, concerns about drug security, effectiveness and cost were associated with the willingness to use PrEP [37]. Studies abroad also reported a relatively high acceptability of PrEP in different population groups [36], [37], [38], [39] and identified several factors associated with the willingness to use PrEP, including cost [36], [37], [38], effectiveness of PrEP medication [36], [37], side effects of medication [36], [37], [38], educational attainment [38], income [38], and perceived discrimination [36]. Furthermore, in assessing the risk of HIV infection among FSWs, empirical research globally has addressed various factors including HIV and STI knowledge [40], [41], [42], [43], work condition [41], [44], income [40], [41], [42], condom use [40], [41], [42], gatekeeper support [13], [45], sexual practices [41], [46], [47], [48], STI/HIV protection methods followed [40], [41], [46], [47], [48]. "
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    ABSTRACT: Acceptability of pre-exposure prophylaxis (PrEP) and willingness to participate in a clinical trial for both safety and efficacy of PrEP were investigated among female sex workers (FSWs) in Guangxi, China. A cross-sectional study was performed in three cities in Guangxi. Structured, self-administered questionnaires were used to assess the acceptability of PrEP and the willingness to participate in a clinical trial. Multivariable logistic regression models were fitted to identify predictors. Among 405 participants, 15.1% had heard of PrEP. If PrEP was deemed to be effective, safe and provided for free, 85.9% reported that they would accept it, and 54.3% of those who accepted PrEP said that they would participate in a clinical trial. The increased acceptability of PrEP was associated with working in male dominated venues, higher income, a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, not being forced to use condoms by the gatekeepers, consistent use of condoms, and use of drugs to prevent STD infection. The increased willingness to participate in a clinical trial was associated with a poor family relationship, better HIV/AIDS knowledge, not realizing HIV risk from unfamiliar clients, a willingness to adhere to daily PreP use, and not being concerned about discrimination by others. The main reason for rejecting PrEP or participating in a clinical trial was the concern about the side effects of PrEP. Acceptability of PrEP among Guangxi FSWs is relatively high, indicating that PrEP intervention programs may be feasible for Chinese FSWs. Given the fact that most of the participants had never heard of PrEP before, and that family, gatekeepers, and social discrimination could significantly affect its acceptability, a comprehensive mix of multiple interventions is necessary for the successful implementation of a PrEP program among this population in Guangxi.
    PLoS ONE 01/2014; 9(1):e86200. DOI:10.1371/journal.pone.0086200 · 3.23 Impact Factor
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    • "Eight articles reported further on multiple attitudinal issues such as willingness to take PrEP, HIV prevention, access to PrEP, perceptions of personal risk, stigma and continued condom use [48, 49, 51, 57, 58, 61, 62, 64, 65]. Two of these reported on scenarios or conjoint analysis [51, 64]. Qualitative-based articles were less specific about particular questions, but reported a wide range of acceptability issues, including: perceptions of transmission risk; feelings about safer sex; information desired about PrEP; concerns with cost, access, side-effects and regular testing [46, 47, 53, 63]. "
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    ABSTRACT: Recent research has demonstrated how antiretrovirals (ARVs) could be effective in the prevention of sexually transmitted HIV. We review research on the acceptability of oral pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) for HIV prevention amongst potential users. We consider with whom, where and in what context this research has been conducted, how acceptability has been approached, and what research gaps remain. Findings from 33 studies show a lack of TasP research, PrEP studies which have focused largely on men who have sex with men (MSM) in a US context, and varied measures of acceptability. In order to identify when, where and for whom PrEP and TasP would be most appropriate and effective, research is needed in five areas: acceptability of TasP to people living with HIV; motivation for PrEP use and adherence; current perceptions and management of risk; the impact of broader social and structural factors; and consistent definition and operationalisation of acceptability which moves beyond adherence.
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