Awareness and use of HIV pre-exposure prophylaxis (PrEP) are found to be low in San Francisco gay and bisexual men

Over the past two years, the media has shown a keen interest in reporting on HIV pre-exposure prophylaxis (PrEP) animal studies presented at AIDS conferences

and in the highly controversial PrEP safety trial conducted amongst African female sex workers . In turn, some speculate that there is a heightened awareness of PrEP as a possible new HIV prevention strategy in gay men and that a significant number are actively using it as an “evening-before pill” prior to engaging in risky sexual behavior.

This speculation was given credence last summer when Scott Kellerman and colleagues from the US CDC presented data at the Third International AIDS Society Conference on HIV Pathogenesis and Treatment in Rio de Janeiro, Brazil, detailing heightened awareness and use of PrEP in urban gay men of color. In the subgroup of men from San Francisco, 29% and 9%, reported awareness and use of PrEP, respectively.

Findings from a study presented last week by Liu and colleagues from the San Francisco Department of Public Health and the University of California, San Francisco at the Sixteenth International AIDS Conference in Toronto seriously call into question this robust awareness and use of PrEP in gay men. A cross-sectional survey of PrEP awareness and knowledge was administered to 851 gay or bisexual men who self-reported having a negative or unknown HIV serostatus. These men were sampled from three different subgroups: 403 men were randomly sampled from San Francisco gay venues; 176 were attendees of a circuit party in Palm Springs; and the third group consisted of 272 men attending the San Francisco STD (sexually transmitted diseases) clinic. Approximately 40% were men of colour; close to 50% were college-educated and about 30% earned $60,000 a year or more. The circuit party sample had significantly more college-educated men and a higher yearly income compared to the San Francisco and sexual health clinic groups. There was a substantial amount of recreation drug use reported in San Francisco and circuit party groups, and 37% and 51%, respectively, reported unprotected anal intercourse.

Overall, 18% of the men had heard of PrEP: San Francisco = 20%; circuit party = 19%: sexual health clinic = 15%. Unprotected anal intercourse in the last six months was the only variable significantly associated with PrEP awareness (adjusted OR: 2.0 [95% CI: 1.3, 3.0]). Newspapers and magazines were overwhelmingly noted as the top source of PrEP knowledge, followed by conversations with friends.

Reports of PrEP use in the entire sample were basically non-existent; only one patient from the sexual health clinic claimed prior use (overall 0.12%). Investigators question the veracity of the patient’s claim because upon further questioning, he reported being administered 30 days of antiretroviral medication from his doctor, and thus probably confused PrEP with post-exposure prophylaxis (PEP).

Importantly, 68% overall said they would take PrEP medication daily if it was found to be safe and effective in preventing HIV transmission. In the multivariate model, independent correlates of anticipated future PrEP use were significant for: 1) men of color; 2) those reporting unprecedented anal intercourse; 3) men noting recreational drug use.

According to Liu, “contrary to prior reports, PrEP use appears to be rare in three different samples of gay and bisexual men.” He did say that because PrEP awareness and anticipated future PrEP use were associated with high risk behaviors, “PrEP use in the future would need to be integrated into existing prevention strategies and would not be a replacement for these measures.” Liu concluded with a call for more “responsible media reporting” because it was the main source of PrEP knowledge in the survey, and that how PrEP is portrayed in the media “could potentially influence how it is used in the community in advance of definitive efficacy data.”