Pre-exposure prophylaxis (PrEP), a daily prevention pill intended for individuals who have not been infected with the human immunodeficiency virus (HIV), has gained support as one approach to preventing infection among high-risk individuals,1 including men who have sex with men (MSM).2 Results of the clinical trial, iPrEx, were released in November 2010, showing daily doses of pre-exposure drugs to be associated with a 44% reduction in HIV prevalence in MSM.3 In the present study, the authors assessed PrEP awareness and uptake, as well as attitudes toward PrEP in two samples of MSM in Denver, Colorado.
Methods and Sample
Participants took part in the National HIV Behavioral Surveillance System (NHBS) MSM cycles. The NHBS is intended to capture HIV prevalence and risk trends, as well as testing behaviors.4 Two samples were recruited, one in 2008 and one in 2011, from various locations (e.g., bars, dance clubs, bathhouses, parks, local grocery stores) in Denver. Eligibility criteria included: 1) being male; 2) being at least 18 years of age; 3) being approached by research staff; 4) being a resident of the Denver-metro area; 5) having the ability to complete an English or Spanish survey; 6) having the ability to provide informed consent; and 6) having not previously completed an interview for the current NHBS-MSM cycle. Voluntary participants in each cycle completed a survey on a handheld computer. Selected sample characteristics are as follows:
- Race/Ethnicity: 63% White/non-Hispanic, 26% Hispanic, 7% other, 3% Black/non-Hispanic
- Age: 18-20, 4%; 21-29, 29%; 30-39, 27%; 40+, 39%
- Ever heard of PrEP: No, 79%; Yes, 21%
- Willing to take daily PrEP, if shown to have few or no side effects: 66% Yes; 33% No
- Race/Ethnicity: 54% White/non-Hispanic, 27% Hispanic, 11% Black/non-Hispanic, 8% other
- Age: 18-20, 2%; 21-29, 36%; 30-39, 28%; 40+, 34%
- Ever heard of PrEP: No, 72%; Yes, 28%
- Willing to take daily PrEP, if shown to have few or no side effects: 62% Yes; 37% No
The results of the study were limited to participants who reported both being HIV-negative and having had oral or anal sex with a man in the previous 12 months.
In 2008, 66% of men were willing to take daily PrEP if shown to have little or no side effects. Sixty percent of men would be willing to take daily PrEP if shown to prevent new HIV in 75% of users, whereas 45% of men would be willing to take daily PrEP if shown to prevent new HIV in 50% of users. The majority of participants reported they would not change their condom use (85%) or their number of sex partners (92%) if they took daily PrEP.
In 2011, 62% of men were willing to take daily PrEP if shown to have little or no side effects. Fifty-six percent of men would be willing to take daily PrEP if shown to prevent new HIV in 75% of users, whereas 44% of men would be willing to take daily PrEP if shown to prevent new HIV in 50% of users. Similar to the 2008 sample, the majority of participants reported they would not change their condom use (78%) or their number of sex partners (85%) if they took daily PrEP.
Accounting for sampling differences, participants in the 2011 sample were 43% more likely to have heard of PrEP. Notably, knowledge of PrEP differed significantly by income in both the 2008 and 2011 samples; those earning higher incomes more frequently reported knowing about PrEP.
The results of the present study demonstrate that knowledge of PrEP remains low, even following the release of the iPrEx clinical trial results in 2010. Given awareness’ vital place in PrEP effectiveness, the authors suggest implementing targeted messages aimed at high-risk individuals that encourage these individuals to discuss PrEP with their providers.
For More Information
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Al-Tayyib, A. A., Thrun, M. W., Haukoos, J. S., & Walls, N. E. (in press). Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men how have sex with men in Denver, Colorado. AIDS and Behavior. doi: 10.1007/s10461-013-0553-6
1 Centers for Disease Control and Prevention. (2013). Pre-exposure prophylaxis (PrEP). Retrieved from http://www.cdc.gov/hiv/prevention/research/prep/
2 Centers for Disease Control and Prevention. (2011). Interim guidance: Preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morbidity and Mortality Weekly Report, 60(3), 65-68.
3 Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., et al. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27): 2587-2589.
4 Gallagher, K. M., Sullivan, P. S., Lansky, A., Onorato, I. M. (2007). Behavioral surveillance among people at risk for HIV infection in the U.S.: The National HIV behavioral Surveillance System. Public Health Reports, 122(Suppl. 1), 32-38.