Willingness to consider using pre-exposure prophylaxis (PrEP) increased between 2011 and 2017 among gay and bisexual men in Australia, while concerns about using it decreased, according to research published in AIDS and Behavior. Community support for PrEP users remained solid.
“We found that attitudes towards PrEP among Australian GBM [gay and bisexual men] have become more positive over time,” comment the authors. “As willingness to use PrEP has increased in Australia, concern about using it has fallen, although concern was still expressed by over a third of Australian HIV-negative and untested men in 2017. This underscores that PrEP may not be attractive to all GBM, particularly those who are apprehensive about taking medication or side effects.”
Large scale PrEP demonstration projects began in New South Wales and Victoria in 2016. In April 2018 the Australian Pharmaceutical Benefits Advisory Committee recommended that the government should subsidise PrEP and allow any doctor to prescribe it to individuals with a medium or high risk of HIV.
Repeated, national, online, cross-sectional surveys of Australian gay and bisexual men were conducted in 2011, 2013, 2015 and 2017. Read more via AIDSmap
Trends in Attitudes to and the Use of HIV Pre-exposure Prophylaxis by Australian Gay and Bisexual Men, 2011–2017: Implications for Further Implementation from a Diffusion of Innovations Perspective
Holt M et al. Trends in attitudes to and use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011-2017: implications for further implementation from a diffusion of innovations perspective. AIDS and Behavior, online edition, https://doi.org/10.1007/s10461-018-2368-y (2018).
Abstract
Using repeated, national, online, cross-sectional surveys of Australian gay and bisexual men (GBM), we analysed trends related to HIV pre-exposure prophylaxis (PrEP). Specifically, we analysed trends in PrEP use, willingness to use PrEP, and concern about using PrEP during 2011–2017. We assessed support for GBM using PrEP and willingness to have sex with men taking PrEP between 2015 and 2017. For time-based analyses, we used multivariate logistic regression, controlling for sampling variations over time. We constructed new scales assessing reduced concern about HIV among PrEP users and non-users in 2017, and used multivariate logistic regression to identify independent correlates of PrEP use (vs. non-use). The analyses included 4567 HIV-negative and untested participants (2011–2017). PrEP use increased from 0.5% in 2011 to 25.5% in 2017 (p < 0.001). Willingness to use PrEP increased from 27.9% in 2011 to 36.5% in 2017 (p < 0.001) while concern about using PrEP fell (52.1–36.1%, p < 0.001). Support for GBM using PrEP remained stable (52.5% in 2015, 51.9% in 2017, p = 0.62), and willingness to have sex with men taking PrEP increased from 34.9% in 2015 to 49.0% in 2017 (p < 0.001). In 2017, 22.8% of non-PrEP-users had reduced HIV concern because of PrEP, while 73.6% of PrEP users had reduced HIV concern and greater sexual pleasure because of PrEP.
The analysis of PrEP users vs. non-users in 2017 indicated that PrEP users were more sexually active and reported higher risk sexual practices, were more likely to live in New South Wales and Victoria, and to be in full-time employment. They were also more likely to know HIV-positive people and other PrEP users. Diffusion of Innovations theory suggests that future PrEP users in Australia may be less adventurous and require greater reassurance about PrEP’s efficacy and legitimacy, to sustain rollout and address current disparities in uptake.