Barcelona 2013
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| Abstract #184 - Prevention | ||||
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Session: 24.5: Prevention (Parallel) on Tuesday @ 11.00-13.00 in Teatre Chaired by Cate Hankins, Juanse Hernandez Authors: Presenting Author: Dr Philippe CG Adam - The University of New South Wales, Australia |
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| Additional Authors: Mr Henry Luyombya, Dr Eleanor Maticka-Tyndale, Dr Alan Li, Dr Josephine Wong, Dr Kenneth Fung, | ||||
| Aim: Pre-exposure prophylaxis (PrEP) offers new opportunities to prevent HIV transmission in high-risk populations including men who have sex with men (MSM). To date, the attitudes of MSM towards PrEP have been mostly documented in studies conducted in the US, the only country where PrEP is available for the public. Some research has also been conducted in the UK and Australia. This paper reports on a study of attitudes regarding PrEP among MSM in France, where PrEP remains accessible only through participation in clinical trials. The study comprehensively assessed knowledge of PrEP, acceptability and willingness to use PrEP for different levels of potential efficacy, as well as expectations of whether using PrEP would reduce condom usage. | ||||
| Method / Issue: An online survey was conducted in 2012 through 11 gay dating sites in France. The survey recruited 932 HIV-negative gay men who provided complete data. Participant knowledge of PrEP was measured with 5-item questions and a summary knowledge score was calculated. Willingness to use PrEP was assessed for 9 levels of potential efficacy, ranging from 30% to 99.9%. For each level of efficacy participants reported their willingness to use PrEP on a seven-point scale (1=Totally disagree, 7=Totally agree). Correlates of willingness to use PrEP were assessed for all levels of PrEP efficacy combined. Participant perceptions of the likelihood that PrEP use would reduce their condom use (risk compensation) were measured with 2 items (alpha=.92); a mean score was calculated across items. Risk compensation was assessed according to levels of safer-sex fatigue, which was measured with 4 items (alpha=.83; items scores were averaged). | ||||
| Results / Comments: One-third (30%) of participants were aware of PrEP prior to survey and knowledge of PrEP among them was moderate (Median=3.11). Intermittent use of PrEP was more acceptable than continuous use (62.8% vs. 24.6%). Willingness to use PrEP relative to efficacy was 12.6% (30% efficacy), 17.5% (50% efficacy), 30% (70% efficacy), 51% (90% efficacy), 61% (95% efficacy) and 83% (99.9% efficacy). In multivariate analysis, willingness to use PrEP was associated with having had unprotected anal intercourse (UAI) with casual partners in the previous six months and low perception of potential side-effects of PrEP. Among men in a steady relationship, willingness to use PrEP was independently associated with UAI with their partner and worry about HIV transmission. While perceived risk compensation was generally low among participants willing to use PrEP (Median=2.66), it was significantly higher among those reporting higher safer-sex fatigue (Median=3.89). | ||||
| Discussion: Findings suggest that most MSM in France remain unfamiliar with PrEP and need to be better informed. Willingness to use PrEP is limited, except where very high levels of protection from infection are offered. Intermittent use of PrEP is preferred by MSM and could increase the number of potential users. A concerning finding is that PrEP use could lead to risk compensation, especially among MSM experiencing safer-sex fatigue. Should PrEP become available in France, reinvigorating behavioural HIV-prevention promoting condom use will be critical to ensure any potential risk compensation is avoided. | ||||
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