Abstract
Men who have sex with men (MSM) are at high risk for acquiring HIV in Belgium. This study explores MSMs’ hypothetical willingness to use pre-exposure prophylaxis (PrEP), assesses it against formal PrEP eligibility criteria, and identifies factors associated with incongruence between eligibility and willingness. We used data from an online survey of n = 1444 self-reported HIV-negative MSM. Participants were recruited through social media of MSM organizations and dating apps. Univariate analysis described PrEP willingness and eligibility; bivariate analyses examined how specific co-variates (socio-demographic, knowledge-related, and attitudinal and behavioral factors) were associated with eligibility and willingness. About 44% were eligible for PrEP and about 70% were willing to use it. Those who were eligible were significantly more likely be willing to take PrEP (p < 0.001). Two incongruent groups emerged: 16% of eligible participants were unwilling and 58% of ineligible participants were willing to use PrEP. Factors associated with this incongruence were sexual risk behavior, HIV risk perception, partner status, PrEP knowledge, and attitudinal factors. Because the two groups differ in terms of profiles, it is important to tailor HIV prevention and sexual health promotion to their needs. Among those at risk but not willing to take PrEP, misconceptions about PrEP, and adequate risk perception should be addressed.
Highlights
In Belgium and Western Europe, new HIV diagnoses have been declining for the last 10 years [1,2].Men who have sex with men (MSM) are still at highest risk for HIV acquisition: In Belgium, more than half of new HIV infections were being diagnosed in this group in 2017 [1]
Were more aware of Pre-exposure prophylaxis (PrEP) (p = 0.017) and were more likely to indicate that their PrEP knowledge was good, when compared with ineligible unwilling participants (p = 0.008; see Table 5). In this online survey among Belgian MSM we aimed to explore the hypothetical willingness to take PrEP and to assess it against the formal PrEP eligibility criteria
We suggest that efforts need to be strengthened to promote PrEP as prevention method for MSM who are eligible for PrEP
Summary
In Belgium and Western Europe, new HIV diagnoses have been declining for the last 10 years [1,2].Men who have sex with men (MSM) are still at highest risk for HIV acquisition: In Belgium, more than half of new HIV infections were being diagnosed in this group in 2017 [1]. In Belgium and Western Europe, new HIV diagnoses have been declining for the last 10 years [1,2]. To further reduce the high number of HIV infections among MSM, primary prevention needs to be strengthened. Pre-exposure prophylaxis (PrEP), the use of antiretroviral treatment as prevention, has shown to be highly efficacious in reducing HIV infection risk, if used correctly [3,4]. Given this efficacy [4], PrEP-related research has increasingly focused on how to implement this novel biomedical prevention tool. Delivery and uptake may need to be upscaled and the implementation periods might have been too short to affect the overall course of the HIV epidemic across Europe [6]
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