Up to a quarter of HIV-negative gay men attending three English clinics used PrEP in the last year

A prospective cohort study of gay men attending three clinics in southern England – 56 Dean Street and Mortimer Market Centre in London and the Brighton & Hove SHAC (Sexual Health & Contraception) service – have found that 23% of HIV-negative service users who responded to a follow-up questionnaire had used PrEP (pre-exposure prophylaxis) in the last year.

These interim results from the AURAH2 study were presented recently at the 16th European AIDS Conference (EACS 2017) in Milan.

There was tentative evidence that some men may have started switching from PEP (post-exposure prophylaxis) as their favoured method of managing possible HIV exposure.

However, this figure is likely to be higher than the actual proportion of clinic users taking PrEP, as there was a high drop-out rate in the survey and a lot of people who completed baseline questionnaires did not return to fill one out a year later.

A second survey just from Dean Street, conducted last April, found that 15% of its eligible gay male service users who had come in for an STI checkup were taking PrEP.

The AURAH2 Study

The AURAH2 (Attitudes to and Understanding of Risk and Acquisition of HIV over time) Study is a prospective cohort study of gay men attending the three clinics. 

AURAH2 recruited its members between 2013 and 2016. HIV-negative men who have sex with men over 18 were included. They were given a baseline paper questionnaire to fill in at the start of the study and were then asked to fill in an online follow-up questionnaire every four months. 

The questionnaires asked about HIV testing, health and lifestyle factors (including recreational drug use and chemsex), recent sexual behaviour and, once a year, PEP and PrEP use.

Although 1167 men completed the baseline questionnaire, only 53% of them (620) subsequently filled in a follow-up online questionnaire and 467 men (40%) provided at least one annual questionnaire about PEP and PrEP use.

In the baseline questionnaires, the average age of participants was 31, 84% were white, 40% were in a relationship, 77% said they were without significant money worries and 83% were in employment. Twenty-one per cent were current smokers, 21% drank the amount of alcohol classed as “higher risk” by the World Health Organization, and 61% had used recreational drugs in the last three months.

The characteristics of the 476 men answering the PEP/PrEP questionnaire were similar, with the exception that slightly fewer of them (16 vs 23%) had significant money worries. 

Because recruitment into the survey took three years, there were changes between the answers given in baseline questionnaires collected in the latter half of 2013, when recruitment started, and ones collected in the first half of 2016, after which it finished.

The proportion aware of PEP was already high and stayed so at about 95% but the proportion who had ever taken it more than doubled from 21% to 49%.

Awareness of PrEP more than doubled, from 43% to 92%. The proportion who had actually taken it tripled, from 4% in 2013 to 11% in 2016.

In the one-year follow-up questionnaire, the proportion who had taken PEP in the year since entering the study did not change overall between the latter half of 2015 (when the first year-one questionnaires were analysed) and the middle of 2017, date of the most recent ones. But the proportion who had taken PrEP during the year doubled, from 12% to 23%. This 23% represented 110 men.

There was an early hint that some might be switching from PEP to PrEP. Till the first quarter of 2017, PEP use looked as if it was on an upward trajectory, with 20% who answered the questionnaire during that quarter recording PEP use in the last year. In the second and third quarters of 2017, it fell to 10%, but it is too early to say if this is a trend or a random finding.

PrEP takers were asked where they had acquired PrEP: 50% said they had bought it on the internet, 39% got it from a doctor, and 11% acquired it both online and from their doctor. As all three clinics participated in the PROUD study, many or most of the 55 men who reported getting it from their doctor may have been in that study.

AURAH2 is still ongoing: its last annual questionnaires will be collected in March 2018, and it will be interesting to see if PrEP use increases due to these clinics being part of the IMPACT study. However, it is clear that still only a minority of gay men who might benefit from PrEP are taking it.

Three-day Dean Street survey finds roughly similar proportion on PrEP

A letter published in Sexually Transmitted Infections journal recently provided more context. It was a survey of patients who attended the Dean Street Express clinic in London over just three days in April 2017.

The clinic provided 507 STI tests in those three days – 169 a day. Seventy service users (14%) had HIV. Of the other 437, 17% (87 men) said they always used condoms and four had had no sexual partners in the last three months.

Fifty-two (15%) of the remaining 352 were taking PrEP and 11 (3%) were currently taking a course of PEP. This left 64% of all testers eligible for PrEP, but either not taking it or not replying to the question – 45% said they definitely had not taken it. This 15% is at least roughly in the same ballpark as the proportion found in AURAH2.

Men who were taking PrEP were more likely to have had condomless anal sex in the last three days (27 vs 12%); were more likely to have had condomless anal sex as the receptive partner in the last three months (90 vs 76%) and had had an average of eight vs four partners, as the receptive partner, during that time.