Pre-exposure prophylaxis (PrEP) is the use of antiretroviral medication by HIV negative people to reduce their risk of contracting HIV. PrEP has been found to be highly effective in preventing HIV in clinical trials and is approved for use in a number of countries, including the US, France, Canada, South Africa and Kenya. NHS England is currently reconsidering its decision not to fund the drug.
Recent clinical trials in the UK and France found that PrEP reduces HIV transmission by up to 86% for MSM. In Scotland, just under half of new HIV infections in 2014 occurred amongst MSM, making them the group most at risk of HIV infection.
Dr Jamie Frankis and Professor Paul Flowers, researchers in Sexual Health and Blood-borne Viruses at GCU, working with Dr Ingrid Young and Dr Lisa McDaid from the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow, conducted 10 in-depth qualitative interviews and a survey with 690 MSM in Scotland. Their results found substantial interest PrEP amongst MSM reporting HIV risk behaviours in Scotland, though relatively little awareness of this HIV prevention method.
Just under half of participants (47.8%) said they were likely to use PrEP if it were available to them. Those MSM who are most at risk of HIV infection in Scotland, namely younger men (18–25 years) and those who report higher risk sexual behaviours, were significantly more likely to say they would use PrEP. These findings demonstrate that those men who are most likely to benefit from PrEP are also the ones who say they are most likely to use it.
Researchers found that men will likely use these medicines as part of their own sophisticated risk reduction strategies, where patterns of sexual practice and social relationships could affect their motivation for and nature of PrEP use. As such, the researchers identified the need for comprehensive support when PrEP is introduced, including a key online component, to ensure equity of awareness across diverse MSM communities (e.g. by geography, education, gay scene use and HIV proximity), as well as to respond to the diverse informational and sexual health needs of all MSM communities.
The study found that under one third (29.7%) of MSM had heard of PrEP, with awareness related to living in large cities, degree level education, commercial gay scene use and reporting an HIV test in the last year. However, awareness was not related to how likely men said they were to use PrEP. This reinforces the notion that information alone is insufficient to support PrEP usage and underlines the need for both awareness-raising and support for PrEP use to enable cost-effective targeting.
GCU researchers used data from the Social Media, MSM and Sexual Health (SMMASH) surveys filled in by over 1,300 men recruited online via gay-specific socio-sexual media websites (Gaydar, Recon and Squirt), smartphone apps (Grindr and Gaydar) and Facebook. These findings were combined with in-depth interviews with HIV negative MSM as part of a wider qualitative study exploring the acceptability of PrEP and treatment as prevention in Scotland conducted by the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Dr Frankis said: “This study adds to the current dialogue around PrEP provision on the NHS by clarifying that those men most likely to benefit from PrEP are also those who are most likely to say they will use it. As such, it has huge potential to reduce HIV transmission in the UK amongst key population groups, along with other risk management strategies including condom use, HIV testing and ‘Treatment as Prevention’. Although men will use PrEP as part of their own sophisticated risk management strategies, relative lack of awareness means that comprehensive services to promote and support PrEP use must underpin any such implementation.”
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