Attitudes and Barriers towards Pre-Exposure Prophylaxis (Prep) among High-Risk HIV-Seronegative Men who have Sex with Men

Abstract

Objective: Recent studies have demonstrated the efficacy of antiretroviral preexposure prophylaxis (PrEP) for prevention of HIV-1 infection. The purpose of this study was to identify barriers to PrEP use among high HIV-risk men who have sex with men in Denver, Colorado. Methods: A 19 question Likert-scale survey was used to assess knowledge of PrEP; attitudes towards cost, side effects, and alternative prevention methods; and the effects of PrEP on sexual behaviors and practices. The survey was administered at study entry and six months later to HIV seronegative, men who have sex with men and male-tofemale transgendered women who have sex with men and participate in high-risk sexual behavior. Results: Between June and September 2013, 65 participants from the metropolitan Denver area completed the survey. Median age was 36 years (range; 20-52 years); 88% were white, 6% Hispanic, and 1.5% African American; 65% had at least a college degree or higher and 27% had more than high school education. The reported number of sexual partners in the past six months ranged from zero to 150 partners (median 3 partners) and 75% reported condom use during all sexual encounters. Although 72.3% reported prior knowledge of PrEP only five participants (7.7%) reported ever using PrEP in the past. Participants were most likely (93.8%) to use PrEP in the future if they were in a monogamous relationship with an HIV-infected partner and least likely to use PrEP if it required out-of-pocket costs (10.7%). Younger age was associated with decreased odds of future PrEP use even if PrEP was provided free of charge (OR 0.2, 95% CI 0.1, 1.0). Higher number of sexual partners in the preceding six months was associated with decreased odds of using condoms if taking PrEP in the future (aOR 0.2; 95% CI 0.1, 0.8). No changes in survey responses were noted between baseline and six months. Conclusions: PrEP usage was uncommon among men at high risk for sexual acquisition of HIV infection and cost of antiretroviral drugs was a major barrier to future PrEP use. If PrEP is to have major impact on transmission of HIV-1, expanded efforts to decrease cost and increase community awareness of PrEP safety and efficacy are needed.