Awareness and use of nonoccupational HIV post‐exposure prophylaxis among people receiving rapid HIV testing in Spain

Abstract

ObjectivesThis paper examines the awareness and use of nonoccupational HIV post-exposure prophylaxis (nPEP) in Spain, and the factors that influence this awareness. MethodsBetween June 2009 and July 2010, a mobile unit offered free, rapid HIV tests in a number of Spanish cities. A total of 2545 people were passively recruited and tested, and answered a self-administered questionnaire containing sociodemographic, behavioural and nPEP-related questions. Bivariate and multivariate analyses were performed, stratifying by gender/sexual behaviour. ResultsSome 34% of the responders were men who have sex with men (MSM), 30% were men who have sex exclusively with women (MSW), and 35% were women. Approximately 26% were foreigners, 46% had a university degree, and 51% had previously taken an HIV test. Overall, 22% were aware of nPEP. Only 2% had ever used it; 70% of these after high-risk sexual intercourse. Awareness was higher among MSM (34%) than women (16%) and MSW (15%). Multivariate analysis showed a lack of nPEP awareness to be associated with being born in Latin America, while awareness increased with the number of previous HIV tests among women and MSW. In MSM, awareness was also associated with having a university degree, the degree of interaction with gay culture, number of partners, and use of the internet as the main way of meeting partners. ConclusionsnPEP awareness in the studied population was unacceptably low. The promotion of its availability should be made a major objective of prevention programmes, as a complementary measure to condom use.Keywords: education, HIV, preventive measures, prophylaxis, public health policy. Accepted 11 September 2012 IntroductionNonoccupational HIV post-exposure prophylaxis (nPEP) has been recommended since 1998 [1]. Guidelines for its use exist in almost every country [2][3][4], and in some, including Spain, nPEP is available at no charge in emergency rooms. The cost-effectiveness of nPEP has been demonstrated, especially for high-risk groups [5] there was some initial concern that being aware of nPEP might encourage high-risk behaviour, the evidence shows this fear to have been unfounded [6]. Those who might need nPEP should be made aware of its existence, and request it immediately after high-risk exposure or condom failures (the frequency of which is not negligible) [7]. A number of authors have attempted to characterize the types of person requesting nPEP at health care facilities [8][9][10][11]. Other studies have examined the knowledge that potential users have of its existence. However, most of these studies have focused entirely on men who have sex with men (MSM) [9,[12][13][14][15], while others have concentrated on HIV-positive persons [16]; almost none have dealt with other groups [17], even though nPEP is being indicated mostly in heterosexual exposure to HIV [9,10].The present study assessed the knowledge and use of nPEP among a more heterogeneous population, including HIV-negative men and women of different sexual orientation and with different sexual behaviour...

Trends in Condom Use and Risk Behaviours after Sexual Exposure to HIV: A Seven-Year Observational Study

“…In France, 70% of individuals reported the knowledge of PEP, mainly MSM [29]. It has been recently reported that awareness of PEP increases with the number of' previous HIV tests [30]. Between 2008 and 201l, HIV prevention campaigns were conducted in France, including HIV-testing for the general population as well as for those with high risk behaviours.…”

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…PEPSE provision is not recommended in cases where the index individual is HIV positive with a viral load of <200copies/ml, regardless of the type of sexual exposure. Convenience samples of HIV negative MSM found that 34% of MSM in Spain and 36% in the USA were aware of PEPSE availability; having a higher number of sex partners was significantly associated (OR 5.1, p=0.02) with higher rates of awareness (387,388). Awareness was higher (52-66%) in MSM living with HIV (389,390).…”

Access to post-exposure prophylaxis following sexual exposure for men who have sex with men in an Irish healthcare setting

“…[19][20][21] However, MSM awareness is greater than other sexual orientations, including women and men who have sex with women. 22 Campaigns and interventions have succeeded to increase PEP awareness in MSM. 23 Injury from discarded needles in the community creates concern for transmission of HIV; however, HIV transmission via community needle-stick injuries (CNSI) has not been documented to date and should be considered extremely low risk, with non-occupational PEP (nPEP) not recommended for these exposures.…”