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Rapid rise in PrEP awareness in US gay men, but only 5% have used PrEP
Roger Pebody, 2016-03-10 08:30:00
Large internet surveys of American gay men show that the
proportion who have heard of pre-exposure prophylaxis (PrEP) jumped from 45% in
2012 to 68% in 2015, with around half of men willing to consider using PrEP –
but that actual usage is far lower and remains concentrated in a few key urban areas
where public health authorities have facilitated its uptake.
Kevin Delaney of the Centers for Disease Control and
Prevention (CDC) presented the data at the recent Conference on Retroviruses and
Opportunistic Infections (CROI 2016) in Boston.
Data came from three large internet-based surveys of gay,
bisexual and other men who have sex with men (MSM) living in the United States,
with recruitment via dating apps and websites, social media and gay websites.
Surveys were conducted in May to August 2012 (2794 participants), December 2013 to
May 2014 (3096 participants) and October 2014 to March 2015 (8406
participants). The Food and Drug Administration (FDA) first approved Truvada for use as PrEP in July 2012.
Awareness of PrEP, willingness to use PrEP and actual use all
increased from survey to survey. In 2012, 45% were aware of PrEP, 39% would
consider using it and 0.5% had actually used it (in the previous 12 months).
In the most recent survey, completed in March 2015, 68% were
aware of it, 50% would use it and 4.9% had actually used it.
“There remains a large gap between the number of MSM who
report being willing to use PrEP and those who actually have done so,” comment
Respondents living in different parts of the country
reported very different levels of PrEP use in the most recent survey – 2% in
people living in rural areas and around 3.5% in most urban areas, but 11% in
Seattle, 12% in New York City, 16% in Washington DC and 17% in San Francisco. In
addition, around 8% of residents of Boston, Philadelphia, Chicago and Los
Angeles reported recent PrEP use.
This likely reflects the impact of public health programmes
in those cities to raise awareness of PrEP among people who could benefit from
it, to train and support healthcare providers, and to reduce bureaucratic and
financial barriers to access. However, in many other parts of the country, such
programmes have not been provided.
Although other studies have reported less engagement with
PrEP among black men, the researchers found that when they made statistical
adjustment for confounding factors such as income, education and sexual
behaviour, black men in this sample had similar levels of awareness,
willingness and use as white men.
Men with more education or a higher income were much more
likely to have heard of PrEP, but no more likely to have used it.
When comparing men who had used PrEP with those who had not,
the key factors relate to sexual behaviour – 6.7% of men with ten or more
sexual partners in the past year had used PrEP (compared to 0.9% of men with
fewer partners), 6.6% of men recruited through a geospatial dating app had used
it (compared to 1.2% of men recruited elsewhere) and 9.8% of those with a
recent sexually transmitted infection (STI) had used PrEP (compared to 1.5% of men
with no STI). Also, 4.9% of those taking part in the most recent survey had
used PrEP, compared to 0.5% of men in the first. All these differences were
highly statistically significant.