Gay, bisexual and other men who have sex with men in New York City rate daily pre-exposure prophylaxis (PrEP) as the most effective HIV prevention strategy when condoms aren’t used, and considerably more effective than treatment as prevention or event-based PrEP, according to survey results published in AIDS and Behavior. Men rated these biomedical approaches far ahead of ‘strategic positioning’ or withdrawal before ejaculation.

The online survey was run between November 2016 and June 2017. While the city’s health department endorsed the “undetectable equals untransmittable” campaign in August 2016, widespread public discussion of U=U came later. In contrast, PrEP education and provision was already well established in New York at the time of the survey, no doubt influencing the results.

But while all HIV-positive participants were aware of treatment as prevention, few believed that it offered “complete protection”.

The 732 participants were all men who have sex with men, living in New York City, recruited through advertisements on Facebook, gay websites and dating apps. As part of a broader survey on sexual health for men who have sex with men, they were asked:

“If an HIV-negative man and an HIV-positive man have anal sex together without condoms, how much protection would the following strategies provide against HIV transmission?” Five strategies were presented. Read more via AIDSmap

Awareness and Perceived Effectiveness of HIV Treatment as Prevention Among Men Who Have Sex with Men in New York City

To assess perceptions of HIV treatment as prevention (TasP), we conducted an online survey of MSM in New York City (n = 732) asking them to rate the effectiveness of different strategies to reduce HIV risk during serodiscordant condomless anal sex between men. Only 6.1% reported not knowing what TasP was, with significantly less awareness among non-gay-identified MSM, men with less education, men who reported fewer anal sex partners in the prior 3 months, and HIV-negative/unaware men who had never used PrEP. The strategy most frequently perceived to offer “a lot” or “complete” protection from HIV was daily PrEP (70.0%), followed by TasP (39.1%), intermittent PrEP (16.6%), strategic positioning (15.8%), and withdrawal before ejaculation (10.8%). Men who were HIV positive, who had ever used PrEP, and who identified as gay/homosexual were significantly more likely to see TasP as effective. Further studies should investigate MSM’s apparent skepticism towards TasP. Read more via AIDS and Behavior