Minimal Awareness and Stalled Uptake of Pre-Exposure Prophylaxis (PrEP) Among at Risk, HIV-Negative, Black Men Who Have Sex with Men

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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Risk factors for loss to follow‐up among at‐risk HIV negative men who have sex with men participating in a research cohort with access to pre‐exposure prophylaxis in coastal Kenya

Journal of the International AIDS Society ◽

10.1002/jia2.25593 ◽

2020 ◽

Vol 23 (S6) ◽

Cited By ~ 1

Author(s):

Elizabeth W Wahome ◽

Susan M Graham ◽

Alexander N Thiong’o ◽

Khamisi Mohamed ◽

Tony Oduor ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Loss To Follow Up ◽

Coastal Kenya ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Hiv Negative

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Health Care–Seeking Behaviors and Perceptions of Provider-Initiated Discussion of Pre-exposure Prophylaxis Among PrEP-Naïve HIV-Negative Men Who Have Sex With Men in Atlanta, Georgia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa165 ◽

2020 ◽

Vol 7 (5) ◽

Author(s):

Susanna L Trost ◽

Udodirim N Onwubiko ◽

Derick B Wilson ◽

David P Holland ◽

Allison T Chamberlain

Keyword(s):

Health Care ◽

At Risk ◽

Health Care System ◽

Health Care Seeking ◽

Care Seeking ◽

Sex With Men ◽

Exposure Prophylaxis ◽

Health Care Seeking Behaviors ◽

Hiv Negative ◽

Care System

Abstract Background Given high rates of HIV among men who have sex with men (MSM) in the United States, there is a need to more effectively leverage the health care system to bolster promotion of pre-exposure prophylaxis (PrEP) to at-risk MSM. Methods Using data collected from a 2018 venue-based cross-sectional survey, we examined factors associated with health care–seeking behaviors, discussing PrEP with a provider, and barriers to PrEP uptake among MSM. Associations between outcomes and respondents’ sociodemographic characteristics and sexual behaviors were assessed using log binomial regression. Results Of 478 MSM, 247 (51%) were PrEP-naïve and HIV-negative. Although 85% of PrEP-naïve MSM reported visiting a health care provider in the past year, only 31% recalled having any provider discuss PrEP. The most frequently cited reasons for not taking PrEP were low perception of personal risk of acquiring HIV (37%) and not knowing enough about PrEP (35%). Those who saw a provider in the last year were less likely than those who did not to cite lack of knowledge as a barrier to use (prevalence rate, 0.66, 95% confidence interval, 0.45–0.96). Conclusions Despite the majority of PrEP-naïve MSM interfacing with the health care system, recollection of discussing PrEP with providers was limited. Increased efforts to equip providers with the tools to discuss PrEP and address pressing concerns with at-risk individuals may help improve PrEP uptake among priority populations.

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Pre-Exposure Prophylaxis Care Continuum, Barriers, and Facilitators among Black Men Who Have Sex with Men in the United States: A Systematic Review and Meta-Analysis

AIDS and Behavior ◽

10.1007/s10461-020-03156-x ◽

2021 ◽

Author(s):

Savanah Russ ◽

Chen Zhang ◽

Yu Liu

Keyword(s):

United States ◽

Systematic Review ◽

Black Men ◽

Meta Analysis ◽

The United States ◽

Barriers And Facilitators ◽

Care Continuum ◽

Sex With Men ◽

Exposure Prophylaxis

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Exploring Gender Differences in PrEP Interest Among Individuals Testing HIV Negative in an Urban Emergency Department

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.5.382 ◽

2018 ◽

Vol 30 (5) ◽

pp. 382-392 ◽

Cited By ~ 3

Author(s):

Jessica Ridgway ◽

Ellen Almirol ◽

Jessica Schmitt ◽

Alvie Bender ◽

Grace Anderson ◽

...

Keyword(s):

At Risk ◽

Emergency Department ◽

Hiv Risk ◽

Behavioral Risk ◽

Self Perception ◽

Subjective Risk ◽

Sex With Men ◽

Not At Risk ◽

Urban Emergency Department ◽

Hiv Negative

PrEP is greater than 90% effective at preventing HIV infection, but many people who are vulnerable to HIV choose not to take PrEP. Among women, men who have sex with women (MSW) and men who have sex with men (MSM) who tested HIV negative in our emergency department, we assessed behavioral risk factors, self-perception of HIV risk, and interest in PrEP linkage. Women had lower odds of perceiving any HIV risk versus no risk than MSM, while Whites had greater odds of perceiving themselves as high risk than Blacks. Age and self-perception of risk were not associated with PrEP interest, but patients who were objectively classified as “at risk” had greater odds of interest in PrEP than those not at risk (p < .01). Discordance between HIV risk self-perception and objective risk demonstrates the limitation of relying on patient self-referral for PrEP based on their own subjective risk perception.

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Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city

AIDS Care ◽

10.1080/09540121.2017.1363364 ◽

2017 ◽

Vol 30 (1) ◽

pp. 9-17 ◽

Cited By ~ 42

Author(s):

Matthew Garnett ◽

Yael Hirsch-Moverman ◽

Julie Franks ◽

Eleanor Hayes-Larson ◽

Wafaa M. El-Sadr ◽

...

Keyword(s):

New York ◽

New York City ◽

Black Men ◽

York City ◽

Transgender Women ◽

Sex With Men ◽

Exposure Prophylaxis

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

European Journal of Public Health ◽

10.1093/eurpub/ckz185.355 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

F Fernandes ◽

P Meireles ◽

M Rocha ◽

J Rojas ◽

H Barros

Keyword(s):

Foreign Country ◽

Diverse Group ◽

Chi Square ◽

Cross Sectional ◽

Exact Test ◽

Before And After ◽

Sex With Men ◽

Reported Data ◽

Exposure Prophylaxis ◽

Hiv Negative

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.

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Masculine ideology and Black men who have sex with men’s interest in HIV pre-exposure prophylaxis (PrEP)

Journal of Health Psychology ◽

10.1177/1359105320941236 ◽

2020 ◽

pp. 135910532094123

Author(s):

Redd Driver ◽

Aerielle M Allen ◽

Stephanie Finneran ◽

Jessica L Maksut ◽

Lisa A Eaton ◽

...

Keyword(s):

Black Men ◽

Behavioral Measures ◽

Self Presentation ◽

Masculine Ideology ◽

Gay Pride ◽

Sex With Men ◽

Traditional Masculinity ◽

Exposure Prophylaxis

We examined how traditional masculinity and stigma surrounding HIV pre-exposure prophylaxis (PrEP) affect PrEP interest among Black men who have sex with men (BMSM). One hundred twenty-three men attending a Black Gay Pride event completed measures assessing traditional masculinity, PrEP stigma, and PrEP interest along with two behavioral measures of interest in PrEP. Results demonstrated that avoidance of femininity directly related to interest in PrEP and indirectly through conformity to heterosexual self-presentation. Further, PrEP stigma differentially moderated both of these relationships. Interventions designed to improve engagement of PrEP for BMSM should be attentive to traditional masculinity as a barrier.

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