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'Less education' associated with PrEP and PEP use: only one in five gay men yet aware of PrEP
Gus Cairns, 2011-09-16 03:30:00
A survey (Mansergh) of 454 HIV-negative gay men in four US cities (New York, Los Angeles, Chicago and San Francisco) has found that men with lower educational attainment (high school only) were more likely to use antiretrovirals informally for HIV prevention, either as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), than men who had had further education.
In a parallel survey of 557 HIV-positive gay men, men with lower educational attainment were, similarly, more likely to share their antiretroviral pills with HIV-negative partners to use as PrEP or PEP.
Taken together, 22% of the men in the two surveys were under 30, 35% in their 30s and 43% 40 or over. A third were black, 38% white and the rest Hispanic or of other ethnicity.
Roughly a third each of the sample had education only to high school level, to some college qualification, or to a university degree.
The survey asked both groups if they had used PrEP or PEP or, in the case of the HIV-positive men, provided it to others, in the last six months.
Informal use of PrEP or PEP was still comparatively uncommon; only a few per cent of those surveyed overall had used ARVs as prevention or provided them in the previous six mnoths.
However men with high-school-only education were two to six times more likely to report using one of these strategies.
In the negative group, 5% of men with only high school education had used PrEP compared with 1% of others, and 8% had used PEP compared with 3% of others.
In the positive group, 6% of men with only high school education had provided PrEP compared with 1% of others and 8% had provided PEP compared with 2%. Men in their 30s and black men were also more likely to provide ARVs to partners for use as PrEP or PEP than other groups.
In multivariate analysis, lower educational level remained statistically significant in the case of PEP, but not with PrEP. HIV-negative men with high-school-only education were 3.5 times more likely to use PEP than others. HIV-positive men with high school-only education were 2.7 times more likely to provide PEP than men with some college education and 9.3 times more likely to provide it than men with university degrees.
This is a survey of informal (non-prescribed) use of ARVs as prevention and, while some of the PrEP/PEP use may reflect difficulties with safer sex, in may also reflect two other things: firstly, gay men and especially black gay men with lower socioeconomic status are more likely to have HIV and may therefore encounter partners with HIV more often or judge themselves to be at higher risk; and secondly gay men with better educations may be better at getting healthcare providers to prescribe PEP or PrEP.
Nonetheless, the authors say, "non-prescribed use of antiretroviral therapy for prophylaxis should be monitored".
Source:1
