20th International AIDS Conference - Melbourne, Australia


THPE189 - Poster Exhibition

The intention to use Pre-Exposure Prophylaxis (PrEP) to prevent HIV-infection among men having sex with men (MSM) in Amsterdam, the Netherlands

J. Bil, U. Davidovich, W. van der Veldt, I. Stolte

Public Health Service of Amsterdam, Cluster Infectious Diseases, Research Department, Amsterdam, Netherlands

Background: Pre-Exposure Prophylaxis (PrEP) is a new biomedical intervention that can reduce the risk of HIV-infection in HIV-negative men who have sex with men (MSM) who engage in high-risk sexual behavior. Although PrEP is not yet available in the Netherlands, it is important to gain insight into the awareness and intention to use PrEP among MSM.
Methods: HIV-negative MSM (n=450) participating in the Amsterdam Cohort Study completed a self-administered questionnaire concerning behavior and PrEP during their 6-monthly visit between June 2012-January 2013. Multinomial logistic regression was used to identify determinants of higher intention to use PrEP.
Results: About half (54%) of the MSM (n=243) were aware of PrEP. Of 448 MSM, 120 (27%) reported a low, 270 (60%) a medium and 58 (13%) a high intention to use PrEP when available. Knowledge about effectiveness and side effects of PrEP was limited. In multivariate analyses (table 1), high-risk MSM were more likely to have a higher intention (vs. low-risk MSM), as were MSM with high self-perceived efficacy to use PrEP and higher perceptions of relief due to PrEP (vs. low perceptions). MSM with high perceptions of shame about using PrEP or worries about side effects were less likely to use PrEP (vs. low perceptions). Among men with a high intention to use PrEP, the intention to use PrEP steeply decreased with increasing costs and about one third of all men would decrease there condom use while using PrEP.

   Medium intention^ aOR (95% CI)High intention ^ aOR(95% CI)Overall p-value*
High-risk MSM (vs. Low-risk MSM)1.75(1.05-2.91)3.60(1.56-8.28)0.008
High perceived self-efficacy to use PrEP (vs. Low perceived self-efficacy)1.24(0.64-2.43)6.08(2.50-14.8)<0.001
High perception of worry about side-effects of PrEP (vs. Low perceptions)0.30(0.12-0.74)0.18(0.06-0.54)0.008
High perceptions of shame about using PrEP (vs. Low perceptions)0.35(0.20-0.63)0.22(0.07-0.71)<0.001
High perceptions of relief due to PrEP (vs. Low perceptions)3.05(1.33-6.98)14.26(5.28-38.5)<0.001
^ Ref. low intention to use PrEP / * Overall p-value adjusted analyses / Note: adjusted for type of steady partner and awareness of PrEP # High-risk MSM defined as having >5 casual partners, receptive unprotected anal intercourse with a casual partner or being diagnosed with gonorrhea, all in the previous 6 months
[Table 1: Multinomial logistic regression analysis]

Conclusions: Among MSM the intention to use PrEP was relatively low, but higher among high-risk MSM. When PrEP would become available in the Netherlands, interventions should focus on increasing knowledge and removing barriers for using PrEP. Also, PrEP prescription should be addressing continuation of condoms use.

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