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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    • "In San Francisco it was reported that participants in the iPrEx trial had good adherence due to clientcentered counseling, education and strong relationships with health care staff[29]. Furthermore, after being educated about the potential of PrEP for the prevention of HIV infection, a large majority of high-risk MSM reported intending to use PrEP to prevent HIV infection, if available[32,33]. Soon newer pharmacologic formulations of PrEP for HIV infection are expected including those with even better tolerance, safer metabolic profile, and longer duration of action[30,34]. "
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    ABSTRACT: Background. The safety and effectiveness studies of emtricitabine-tenofovir disoproxil fumarate (FTC-TDF) for HIV infection pre-exposure prophylaxis (PrEP) in men and women showed that daily use reduced the risk of HIV acquisition, but there still may concerns about safety. Methods. A narrative review was done in September 2015 comparing the five major studies on PrEP for HIV infection—Preexposure Prophylaxis Initiative (N=2,499; 3,324 person-years), Partners Preexposure Prophylaxis (N=4,747; 7,830 person-years), TDF2 (N=1,219; 1,563 person-years), Preexposure Prophylaxis Trial for HIV Prevention among African Women (N=2,056; 1,407 person-years), and Vaginal and Oral Interventions to Control the Epidemic (N=4,969; 5,509 person-years)—and the two major studies on aspirin safety—Physicians' Health Study (N=22,071; over 110,000 person-years) and the Women Health Study (N=39,876; nearly 400,000 person-years). The numbers needed to harm (NNH) were calculated for FTC-TDF for HIV infection PrEP and aspirin. Results. The NNH for FTC-TDF in men who have sex with men and transgender women was 114 for nausea and 96 for unintentional weight loss; in heterosexual couples, the NNH was 68 for moderate decreased absolute neutrophil count. For aspirin, the NNH was 909 for major gastrointestinal bleeding, 123 for any gastrointestinal bleeding, and 15 for any bleeding problems in men. In women, the NNH for easy bruising was 10. Conclusions. We conclude that FTC-TDF for PrEP for HIV infection favorably compares to aspirin in terms of user safety. While long-term studies are needed, providers should feel reassured about the safety of short- and medium-term PrEP for HIV infection with FTC-TDF.
    Full-text · Article · Jan 2016 · Open Forum Infectious Diseases
    • "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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    • "In [13] it has been shown that the side effect of daily preexposure with tenofovir disoproxil fumarate (TDF) is acceptable while in [14] it has been shown that HIV infection rates of women is decreased up to 39% using a tenofovir 1% vaginal gel. For men and transgender women who have sex with men the current use of preexposure prophylaxis is not common, however most of these people are willing to consider such use if evidence of safety and efficacy were provided [15,16]. We now briefly discuss the experiments of [9]. "
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