Pre‐exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population

Uthappa, C.K.; Allam, Ramesh Reddy; Pant, Rashmi; Pal, Suman; Dinaker, Manjunath; Oruganti, Ganesh; Yeldandi, VV

doi:10.1111/hiv.12572

Cited by 27 publications

(21 citation statements)

References 30 publications

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“…However, following a brief description of oral PrEP, over half of PWID and MSM reported willingness to use PrEP, with a higher percentage of MSM than PWID expressing willingness. Our results match similar findings of low awareness but higher willingness to use PrEP among MSM and transgender individuals that have been published in India and other countries in the region, such as Myanmar, Vietnam and Thailand [16,17,[26][27][28][29][30] There is a paucity of data on awareness and willingness to use PrEP among PWID, particularly in low-or middle-income countries, which makes our study, including two key populations, unique. The wide variability in willingness to use PrEP (for both groups) across different cities was notable.…”

Section: Discussionsupporting

confidence: 90%

“…Of these, 10,538 PWID and 8,621 MSM did not self-report an HIV-positive status (i.e., they reported their HIV status as either negative or unknown) and were included in the analysis. Across the 22 study sites, the median (range) number of RDS recruitment waves was 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], and median time to complete enrollment was 154 days (95-269). Equilibrium for the main factor of interest (i.e., PrEP awareness) was reached in all sites with the exception of one, Coimbatore (MSM), in which there were 9 waves of recruitment and awareness was still increasing (38.3% in wave 8 to 41.4% in wave 9) [7].…”

Section: General Characteristics Of Pwid and Msmmentioning

confidence: 99%

“…However, PrEP is not yet provided for free as part of the national program, though guidelines are currently under development. Studies done in limited geographies of India indicate that there is low awareness and higher willingness to use PrEP in India, but these were done among MSM and transgender individuals (TG) and the sample sizes were small [16,17]. There is still paucity of information about PrEP awareness and willingness to use PrEP from other geographies of India and among PWID.…”

Section: Introductionmentioning

confidence: 99%

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Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey

et al. 2021

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Introduction Pre-exposure prophylaxis (PrEP) is effective in reducing HIV transmission among key populations. In India, where PrEP is not currently part of the national HIV program, little is known about PrEP awareness, willingness to use PrEP, and barriers to uptake among people who inject drugs (PWID) and men who have sex with men (MSM). Methods We used respondent-driven sampling to accrue PWID and MSM in 22 sites from August 2016 to May 2017. Participants were asked about awareness of PrEP, willingness to use PrEP (following a brief description) and reasons why they might not be willing to use PrEP. Participants were also queried on preferences for PrEP delivery modality (oral vs. injectable). Multi-level logistic regression models were used to determine participant correlates of willingness to use PrEP. Estimates were weighted for the sampling method. Results A total of 10,538 PWID and 8,621 MSM who self-reported being HIV-negative were included in the analysis. Only 6.1% (95% confidence interval [CI]: 5.9, 6.3) of PWID and 8.0% of MSM (95% CI: 7.7, 8.4) were aware of PrEP. However, willingness to use PrEP was substantially higher in both groups: 52.4% of PWID and 67.6% of MSM. Participants commonly cited a perceived low risk for acquiring HIV infection, being perceived by others as being HIV-positive, and side effects as reasons why they would be unwilling to use PrEP. Among PWID, sharing needles and hazardous alcohol use were associated with increased willingness to use PrEP. Among MSM, having a main male partner and injection drug use were associated with increased willingness to use PrEP. Preference for daily oral or monthly injectable PrEP was similar among MSM (39.6%% vs. 41.7%,), while PWID were more likely to prefer oral to injectable administration routes (56.3% vs. 31.1%). Conclusions As India plans to roll-out of PrEP in the public sector, our multi-city survey of PWID and MSM highlights the need for key population-focused education campaigns about PrEP and self-assessment of risk.

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Section: Discussionsupporting

confidence: 90%

Section: General Characteristics Of Pwid and Msmmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey

et al. 2021

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“…Our findings of participants' not feeling at sufficient risk and not knowing whether PrEP was appropriate and effective are consistent with previous studies. 21,[41][42][43][51][52][53] The discordance between these perceptions and being at risk for HIV stands out as a target in optimizing access. Perceived risk is a known determinant of health behaviours 54 and can be harnessed in promoting behaviour change.…”

Section: Discussionmentioning

confidence: 99%

Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study

Cox¹,

Apelian²,

Moodie³

et al. 2021

cmajo

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T he HIV epidemic continues to disproportionately affect gay, bisexual and other men who have sex with men (GBM) in Canada. Although GBM account for 2%-3% of the Canadian population, they represent almost half of all prevalent and newly reported cases of HIV infection. [1][2][3] The disease burden is concentrated in Canada's 3 largest cities -Montréal, Toronto and Vancouver -where many GBM reside. 4,5 HIV pre-exposure prophylaxis (PrEP) with antiretroviral medication (tenofovir disoproxil fumarate or tenofovir alafenamide combined with emtricitabine) has been shown to be effective in preventing HIV infection in HIV-negative GBM. [6][7][8] The Canadian guideline on HIV PrEP provides clinical criteria for use of this intervention among those at high risk for HIV infection, including GBM. 9 Pre-exposure prophylaxis was approved in Canada in 2016 10 and is increasingly available. It was approved in Quebec in 2013, [11][12][13][14] in Ontario in 2017 15 and in British Columbia in 2018. 16 Documenting PrEP uptake and related barriers, especially among GBM who may benefit, is important, as this intervention

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“…However, even with equal access, a number of other important barriers limit PrEP use in GBM. Previous research has shown that low perceived risk for HIV [ 19 , 20 ], low social norms around PrEP (particularly among racial or ethnic minority GBM) [ 21 , 22 ], persistent PrEP stigma [ 23 ], and low uptake and adherence self-efficacy [ 24 , 25 ] are among the most important factors determining PrEP use. Unhealthy alcohol use could also make success on PrEP difficult.…”

Section: Introductionmentioning

confidence: 99%

Game Plan—a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis

Wray¹,

Chan²,

Guigayoma³

et al. 2022

JMIR Form Res

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Background HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult.

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Pre‐exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population

Abstract: With high acceptability and a low likelihood of risk compensation behaviour, PrEP can be considered as an effective prevention strategy for HIV infection among MSM and TGs in India.

Cited by 27 publications

References 30 publications

Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey

Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey

Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study

Game Plan—a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis

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