scholarly journals Pre-exposure prophylaxis makes it possible to better live one’s sexuality and guide men who have sex with men towards a responsible approach to their health: a phenomenological qualitative study about primary motivations for PrEP

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Marie Bistoquet ◽  
Alain Makinson ◽  
Vincent Tribout ◽  
Cyril Perrollaz ◽  
Gérard Bourrel ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Phenomenological Study ◽  
Family Doctor ◽  
Motivational Factors ◽  
Social Representation ◽  
University Hospital ◽  
Sexual Life ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) for HIV is instrumental in the prevention of HIV for HIV-uninfected persons, by drastically reducing the risk of acquisition in the case of high-risk exposures. Despite its demonstrated efficacy, it remained under-prescribed in France until 2018. The principal aim of this study was to understand the motivations of Men who have Sex with Men (MSM) who started using PrEP in Montpellier, France. Methods A phenomenological study was undertaken, using semi-structured interviews with twelve participants attending the University Hospital of Montpellier for PrEP. Interviews were analysed by means of triangulation up to the point of theoretical saturation, using a semio-pragmatic method. Results Fear of HIV infection, personalised regular follow-up, and the wish to take care of one’s health were the primary motivational factors. PrEP allows for a better sexual life restoring a sense of freedom despite the risks of STI, deemed manageable by PrEPers. PrEP does not modify long-term risk-taking behaviours but helps them better live their own sexuality and guides them towards a responsible approach to sexuality. Unclear information on PrEP, delivered by their family doctor, public campaigns or the media, leads to misrepresentations or negative social representation, including within the MSM community, which may delay its implementation. Conclusions Fear of HIV infection and the benefits of regular medical follow-up to take care of one’s health were motivational factors of importance for the use of PrEP by MSM in this study. PrEP transforms all existential dimensions of their lived experience, improving sexual identity and happiness. There is a need to improve professional awareness of the effectiveness of PrEP and to develop a patient centered approach, to disseminate information more widely to the general public and among MSM to reduce stigmatisation.

scholarly journals How to Identify Potential Candidates for HIV Pre-Exposure Prophylaxis: An AI Algorithm Reusing Real-World Hospital Data

2021 ◽  
Author(s):  
Jean-Charles Duthe ◽  
Guillaume Bouzille ◽  
Emmanuelle Sylvestre ◽  
Emmanuel Chazard ◽  
Cedric Arvieux ◽  
...  
Keyword(s):  
At Risk ◽  
Hiv Infection ◽  
Hiv Risk ◽  
Hiv Infections ◽  
University Hospital ◽  
Hospital Data ◽  
Sexual Health Care ◽  
Patients At Risk ◽  
Sex With Men ◽  
Exposure Prophylaxis

HIV Pre-Exposure Prophylaxis (PrEP) is effective in Men who have Sex with Men (MSM), and is reimbursed by the social security in France. Yet, PrEP is underused due to the difficulty to identify people at risk of HIV infection outside the “sexual health” care path. We developed and validated an automated algorithm that re-uses Electronic Health Record (EHR) data available in eHOP, the Clinical Data Warehouse of Rennes University Hospital (France). Using machine learning methods, we developed five models to predict incident HIV infections with 162 variables that might be exploited to predict HIV risk using EHR data. We divided patients aged 18 or more having at least one hospital admission between 2013 and 2019 in two groups: cases (patients with known HIV infection in the study period) and controls (patients without known HIV infection and no PrEP in the study period, but with at least one HIV risk factor). Among the 624,708 admissions, we selected 156 cases (incident HIV infection) and 761 controls. The best performing model for identifying incident HIV infections was the combined model (LASSO, Random Forest, and Generalized Linear Model): AUC = 0.88 (95% CI: 0.8143-0.9619), specificity = 0.887, and sensitivity = 0.733 using the test dataset. The algorithm seems to efficiently identify patients at risk of HIV infection.

scholarly journals A Young Black MSM on PrEP Is Lost to Follow-Up and Acquires HIV Infection: A Case to Call for Improved Strategies to Support Youth Adherence and Engagement in HIV Prevention

2019 ◽  
Vol 18 ◽  
pp. 232595821985383 ◽  
Author(s):  
Ketzela Jacobowitz Marsh ◽  
Meghan Rothenberger
Keyword(s):  
Hiv Prevention ◽  
Hiv Infection ◽  
Sexual Behaviors ◽  
The United States ◽  
Black Msm ◽  
Sex With Men ◽  
Young Black Msm ◽  
Exposure Prophylaxis ◽  
Lost To Follow Up

Young men who have sex with men (YMSM) are disproportionately affected by HIV in the United States. High-risk sexual behaviors are difficult to modify; thus, HIV pre-exposure prophylaxis (PrEP) with a daily pill is a promising prevention tool for this vulnerable population. We present a case of a young black MSM who was able to successfully access PrEP with the help of a community program but was not able to adhere to the regimen or engage in care. He ultimately acquired HIV infection. We review the existing literature and advocate for increased services and research to support youth’s adherence to PrEP and engagement in HIV prevention programs, with a focus on YMSM of color.

An outbreak of syphilis in Oslo

2002 ◽  
Vol 13 (6) ◽  
pp. 370-372 ◽  
Author(s):  
A M Halsos ◽  
K Edgardh
Keyword(s):  
Public Health ◽  
Hiv Infection ◽  
Medical Records ◽  
University Hospital ◽  
Oral Sex ◽  
Sexual Contacts ◽  
Male Patients ◽  
Sex With Men ◽  
Latent Syphilis ◽  
Retrospective Investigation

During 1999 and 2000, an outbreak of syphilis occurred in Norway: 93 cases were reported to the National Institute of Public Health. This report summarizes a retrospective investigation of the medical records of 60 patients with primary, secondary and early latent syphilis treated during 1999–2000 at the Department of STD at the Ullevål University Hospital in Oslo. Five women and 55 men were treated, mean age 38.6 and 44.9 years, respectively. Of the 60 cases, 14 (23.3%) had primary, 39 (65.0) secondary and seven (11.7%) early latent syphilis. Men who have sex with men (MSM) constituted 78.2% (43/55) of the male patients. Transmission among MSM was related to casual sexual contacts in bathhouses in Oslo. Two cases occurred among men with previously diagnosed HIV infection. Two new cases of HIV were reported. Condom use was inconsistent, and seldom used for oral sex.

scholarly journals Southern African guidelines for the safe use of pre-exposure prophylaxis in men who have sex with men who are at risk for HIV infection

2012 ◽  
Vol 13 (2) ◽  
Author(s):  
Southern African HIV Clinicians Society Consensus Committee
Keyword(s):  
At Risk ◽  
Renal Function ◽  
Hiv Prevention ◽  
Hepatitis B ◽  
Hiv Infection ◽  
Creatinine Clearance ◽  
Fixed Dose ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Hiv Negative

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.

scholarly journals 1701. Added Benefits of Pre-exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement among Men Who Have Sex with Men

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S833-S833
Author(s):  
Alyson L Singleton ◽  
Brandon D Marshall ◽  
Xiao Zang ◽  
Amy S Nunn ◽  
William C Goedel
Keyword(s):  
African American ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Treatment Engagement ◽  
Hiv Incidence ◽  
Black African ◽  
African American Msm ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
High Treatment

Abstract Background Although there is ongoing debate over the need for substantial increases in PrEP use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use in settings with high treatment engagement across variable sub-epidemics in the United States. Methods We used a previously published agent-based network model to simulate HIV transmission in a dynamic network of 17,440 Black/African American and White MSM in Atlanta, Georgia from 2015 to 2024 to understand how the magnitude of reductions in HIV incidence attributable to varying levels of PrEP use (0–90%) changes in potential futures where high levels of treatment engagement (i.e. the UNAIDS ‘90-90-90’ goals and eventual ‘95-95-95’ goals) are achieved and maintained, as compared to current levels of treatment engagement in Atlanta (Figure 1). Model inputs related to HIV treatment engagement among Black/African American and White men who have sex with men in Atlanta. A comparison of current levels of treatment engagement (Panel A) to treatment engagement at ‘90-90-90’ (Panel B) and ‘95-95-95’ goals (Panel C). Results Even at achievement and maintenance of ‘90-90-90’ goals, 75% PrEP coverage reduced incidence rates by an additional 67.9% and 74.2% to 1.53 (SI: 1.39, 1.70) and 0.355 (SI: 0.316, 0.391) per 100 person-years for Black/African American and White MSM, respectively (Figure 2), compared to the same scenario with no PrEP use. Additionally, an increase from 15% PrEP coverage to 75% under ‘90-90-90’ goals only increased person-years of PrEP use per HIV infection averted, a measure of efficiency of PrEP, by 8.1% and 10.5% to 26.7 (SI: 25.6, 28.0) and 73.3 (SI: 70.6, 75.7) among Black/African American MSM and White MSM, respectively (Figure 3). Overall (Panel A) and race-stratified (Panel B and Panel C) marginal changes in HIV incidence over ten years among Black/African American and White men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: All changes are calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Person-years of pre-exposure prophylaxis use per HIV infection averted among Black/African American (Panel A) and White (Panel B) men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: The number of HIV infections averted is calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Conclusion Even in the context of high treatment engagement, substantial expansion of PrEP use still contributes to meaningful decreases in HIV incidence among MSM with minimal changes in person-years of PrEP use per HIV infection averted, particularly for Black/African American MSM. Disclosures All Authors: No reported disclosures

scholarly journals HIV and other STIs self-testing to reduce risk compensation among men who have sex with men who use oral pre-exposure prophylaxis in China: protocol for a randomised waitlist-controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036231
Author(s):  
Jing Zhang ◽  
Xiaojie Huang ◽  
Yaokai Chen ◽  
Hui Wang ◽  
Yonghui Zhang ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Sexual Partners ◽  
Risk Compensation ◽  
Standard Facility ◽  
Self Testing ◽  
Condomless Anal Intercourse ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact

IntroductionPre-exposure prophylaxis (PrEP) reduces the risk of HIV infection among men who have sex with men by up to 99%. However, in real-world settings, PrEP users may exhibit risk compensation after uptake of PrEP, including more condomless anal intercourse (CAI) and increased sexually transmitted infection (STI) acquisition. HIV self-testing (HIVST) decreases CAI among men who have sex with men (MSM) by providing awareness of the HIV status of oneself and one’s sexual partners. Here, we describe the rationale and design of a randomised waitlist-controlled trial to examine the impact of HIVST on risk compensation among PrEP users.Methods and analysisThe study is a two-arm randomised waitlist-controlled trial with 1000 HIV-negative MSM in four major cities in China who will be taking oral PrEP (involving tenofovir disoproxil fumarate/emtricitabine) either daily (n=500) or in an event-driven regimen (n=500). The participants will be randomised (1:1) to either the immediate HIVST intervention arm (HIVST plus standard facility-based counselling and testing from 0 to 12 months) or the waitlist arm (standard facility-based counselling and testing from 0 to 6 months, then crossover to receive the HIVST intervention in months 7–12). Participants will provide blood samples to assess the incidence of syphilis and herpes simplex virus type 2 (HSV-2) during a follow-up. The primary outcomes will be the occurrence of CAI, number of sexual partners and incidence of syphilis and HSV-2 during a follow-up. The secondary outcomes will be the HIV and STI testing frequency and STI treatment adherence during a follow-up. The planned start and end dates for the study is 26 December 2018 and 31 December 2020.Ethics and disseminationThe Medical Science Research Ethics Committee of The First Affiliated Hospital of China Medical University has approved the study (IRB(2018)273).Trial registration numberChiCTR1800020374

scholarly journals Sex frequency and sex planning among men who have sex with men in Bangkok, Thailand: implications for pre‐ and post‐exposure prophylaxis against HIV infection

2010 ◽  
Vol 13 (1) ◽  
pp. 13-13 ◽  
Author(s):  
Frits Griensven ◽  
Warunee Thienkrua ◽  
Wichuda Sukwicha ◽  
Wipas Wimonsate ◽  
Supaporn Chaikummao ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Sex With Men ◽  
Exposure Prophylaxis
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