HIV-negative male couples’ attitudes about pre-exposure prophylaxis (PrEP) and using PrEP with a sexual agreement

Background. The use of oral antiretrovirals to prevent HIV infection among HIV-negative men who have sex with men (MSM) has been shown to be safe and efficacious. A large, randomised, placebo-controlled trial showed a 44% reduction in the incidence of HIV infection among MSM receiving a daily oral fixed-dose combination of tenofovir disoproxil fumarate and emtricitabine (Truvada) in combination with an HIV prevention package. Improved protection was seen with higher levels of adherence. Aim. The purpose of this guideline is to: (i) explain what pre-exposure prophylaxis (PrEP) is; (ii) outline current indications for its use; (iii) outline steps for appropriate client selection; and (iv) provide guidance for monitoring and maintaining clients on PrEP. Method. PrEP is indicated for HIV-negative MSM who are assessed to be at high risk for HIV acquisition and who are willing and motivated to use PrEP as part of a package of HIV prevention services (including condoms, lubrication, sexually transmitted infection (STI) management and risk reduction counselling). Recommendations. HIV testing, estimation of creatinine clearance and STI and hepatitis B screening are recommended as baseline investigations. Daily oral Truvada, along with adherence support, can then be prescribed for eligible MSM. PrEP should not be given to MSM with abnormal renal function, nor to clients who are unmotivated to use PrEP as part of an HIV prevention package; nor should it be commenced during an acute viral illness. Three-monthly follow-up visits to assess tolerance, renal function, adherence and ongoing eligibility is recommended. Six-monthly STI screens and annual creatinine levels to estimate creatinine clearance are recommended. Hepatitis B vaccination should be provided to susceptible clients. Gastro-intestinal symptoms and weight loss are common side-effects, mostly experienced for the first 4 - 8 weeks after initiating PrEP. There is a risk of the development of antiretroviral resistance among those with undiagnosed acute HIV infection during PrEP initiation and among those with sub-optimal adherence who become HIV infected while on PrEP. Risk compensation (increasing sexual behaviours that can result in exposure to HIV) while on PrEP may become a concern, and clinicians should continue to support MSM clients to continue to use condoms, condom-compatible lubrication and practice safer sex. Research is ongoing to assess optimum dosing regimens, potential long-term effects and alternative PrEP medications. Recommendations for the use of PrEP among other at-risk individuals, and the components of these recommendations, will be informed by future evidence. S Afr J HIV Med 2012;13(2):40-55.

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Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

Gates Open Research ◽

10.12688/gatesopenres.12752.2 ◽

2018 ◽

Vol 1 ◽

pp. 3 ◽

Cited By ~ 7

Author(s):

Renee Heffron ◽

Kenneth Ngure ◽

Josephine Odoyo ◽

Nulu Bulya ◽

Edna Tindimwebwa ◽

...

Keyword(s):

Hiv Infections ◽

Hiv Treatment ◽

Demonstration Project ◽

Hiv Incidence ◽

Serodiscordant Couples ◽

Treatment Services ◽

Hiv Serodiscordant Couples ◽

Exposure Prophylaxis ◽

Living With Hiv ◽

Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk. Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART). We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP. Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected. Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services. Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV. Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

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Viral hauntology: Specters of AIDS in infrastructures of gay sexual sociability

10.31235/osf.io/ypgsv ◽

2020 ◽

Author(s):

Kristian Møller ◽

Chase Ledin

Keyword(s):

Viral Load ◽

Hiv Infection ◽

Case Studies ◽

Viral Transmission ◽

Hiv Treatment ◽

Social Lives ◽

Medical Regimen ◽

Somatic Condition ◽

Exposure Prophylaxis ◽

Hiv Negative

In recent years, HIV treatment has become so effective that a patients’ viral load can become so low that it is undetectable, which in turn reduces the risk of viral transmission to zero. At the same time for people who are HIV negative, the use of the medical regimen “pre-exposure prophylaxis”, or “PrEP”, reduces the risk of HIV infection by 92%-99%. In case studies of "the PrEP whore" and health disclosure on gay hookup apps, we think about HIV/AIDS not only as a somatic condition affecting a body, but also as a socio-technical matter. We argue that our concept of "viral hauntology" allows us to think deeply about how “old” technologies and their social lives fold over and into new ones, and how the folding process “drags” in order to imagine other, more inclusive, gay socio-sexual futures.

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PEP as a potential antecedent to PrEP among an online sample of HIV-negative and unknown status cis- and transgender sexual minority men: A cross-sectional study (Preprint)

10.2196/preprints.31237 ◽

2021 ◽

Author(s):

Steven A. John ◽

K. Marie Sizemore ◽

Ruben H. Jimenez ◽

S. Scott Jones ◽

Andrew E. Petroll ◽

...

Keyword(s):

Drug Use ◽

Sexual Minority ◽

Multivariable Analysis ◽

Sexual Minority Men ◽

Club Drug Use ◽

Unknown Status ◽

Minority Men ◽

Exposure Prophylaxis ◽

Club Drug ◽

Hiv Negative

BACKGROUND HIV disproportionately affects sexual minority men (SMM) in the U.S. OBJECTIVE We sought to determine past HIV post-exposure prophylaxis (PEP) use and current pre-exposure prophylaxis (PrEP) use among an online sample of cisgender and transgender men who have sex with men. METHODS In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other online venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP and current PrEP use. We examined associations of demographics, socioeconomic indicators, recent club drug use, and current PrEP use on past PEP use using fully-adjusted logistic regression. RESULTS Prior PEP use was relatively uncommon (11.3%), with 2.66 times more men reporting current PrEP use (30.1%). Most (85.9%) past PEP users were current PrEP users, representing 32.2% of all current PrEP users. In multivariable analysis, current PrEP users had 20.1 times higher odds (95%CI: 18.6-21.6) of past PEP use compared to non-PrEP users. Other factors significantly (p<0.001) associated with past PEP use but with smaller effect sizes included: older age (>24 years old) compared to younger age (AOR=1.15); bisexual identity compared to gay (AOR=0.86); Latino, Black, and other/multiracial race/ethnicity compared to white, individually (AORs=1.37-1.52); having health insurance (AOR=0.80); and recent club drug use (AOR=1.19). CONCLUSIONS Prior PEP use was relatively uncommon in our online sample of SMM, but our findings indicate PEP could potentially be a gateway to PrEP. Advertising and prescribing PEP could support efforts to increase PrEP.

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Awareness and Correlates of HIV Pre-Exposure Prophylaxis (PrEP) Among HIV-negative People Who Access Syringe Services in Seattle, Washington

Substance Use & Misuse ◽

10.1080/10826084.2021.2012688 ◽

2021 ◽

pp. 1-7

Author(s):

Maria A. Corcorran ◽

John D. Scott ◽

Joe Tinsley ◽

Anna Wald ◽

Sara N. Glick

Keyword(s):

Exposure Prophylaxis ◽

Hiv Negative

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Influencing Factors of Pre-Exposure Prophylaxis Self-Efficacy Among Men Who Have Sex With Men

American Journal of Men s Health ◽

10.1177/1557988319847088 ◽

2019 ◽

Vol 13 (2) ◽

pp. 155798831984708 ◽

Cited By ~ 3

Author(s):

Dou Qu ◽

Xiaoni Zhong ◽

Minqing Lai ◽

Jianghong Dai ◽

Hao Liang ◽

...

Keyword(s):

Influencing Factors ◽

Rural Areas ◽

Self Efficacy ◽

Urban Areas ◽

Linear Regression Analysis ◽

Univariate Analysis ◽

Anxiety Score ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Hiv Negative

This research examines the level of pre-exposure prophylaxis (PrEP) self-efficacy among HIV-negative men who have sex with men (MSM) in China and identifies the influencing factors associated with the level of PrEP self-efficacy in terms of social-demographic characteristics and social psychological factors. The data were gathered from a baseline assessment of a longitudinal randomized controlled intervention trial. From April 2013 to March 2015, nonprobability sampling was used to recruit HIV-negative MSM at Chongqing, Guangxi, Xinjiang, and Sichuan in west China. A total of 1884 HIV-negative MSM were analyzed. Chi-square test and nonparametric rank sum test were used for univariate analysis. Multivariable linear regression analysis was used to discuss the factors that influence the level of PrEP self-efficacy. Overall levels of PrEP self-efficacy were low, and five factors were found to effect PrEP self-efficacy: age, residence, AIDS-related knowledge, PrEP-related motivation, and anxiety. Age and anxiety score were negatively related to PrEP self-efficacy. The higher the age and anxiety score, the lower the PrEP self-efficacy. AIDS-related knowledge and PrEP-related motivation were actively related to PrEP self-efficacy. The higher the knowledge and motivation score, the higher the PrEP self-efficacy. In addition, the PrEP self-efficacy level of MSM in rural areas is lower than that in urban areas. The lower level of self-efficacy in the MSM population needs to be improved. Pertinent interventions should be taken to promote the self-efficacy of PrEP in MSM, to enhance their willingness to take medicine, improve their medication adherence, and thus reduce HIV infection among MSM.

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