Knowledge, Attitudes and Beliefs regarding Post Exposure Prophylaxis among South African Men who have Sex with Men.

Abstract

The Soweto Men's Study (2008), demonstrated an overall HIV prevalence rate of 13.2%, with 10.1% among straight-identified Men-who-have-sex-with-men (MSM), 6.4% among bisexual-identified MSM and 33.9% among gay-identified MSM. Behavioral interventions are imperative, but insufficient to prevent new HIV infections. Biomedical prevention of HIV offers a variety of combination prevention tools, including Post-exposure prophylaxis (PEP). PEP studies amongst MSM have been conducted in Amsterdam, Brazil and San Francisco, but never before in Africa. A cross-sectional, Internet-based survey was initiated to measure knowledge, attitudes and beliefs regarding PEP among South African MSM. Recruitment commenced in June 2014 and ran until October 2015. Participants were recruited through banner advertisements on Facebook.com and mambaonline.com, advertisements in the local gay media and at Health4Men (H4M) MSM-targeted clinics. Outreach workers distributed flyers advertising the study in their local communities. The survey was also made available on a computer at the H4M clinics in Cape Town and Johannesburg to reach MSM who may not have Internet access. A total of 408 men completed the survey. The majority of these men were under the age of 40, identified as gay/homosexual and were employed; 51% (208/408) self-identified as black or of mixed race. In multivariate analysis participants who identified as gay had greater odds of having previously heard of PEP (AOR 1.91, 95% CI 1.04, 3.51; p=0.036), as did those who reported their HIV status as positive (AOR 2.59, 95% CI 1.47, 4.45; p=0.001). Participants with medical insurance had greater odds of having used PEP previously (AOR 2.67, 95% CI 1.11, 6.43; p=0.029). Bivariate analysis showed that condomless sex in the past 6months was not significantly associated with PEP knowledge (p=0.75) or uptake (p=0.56) of PEP. Our findings suggest a lack of PEP knowledge and uptake among non-gay identified, HIV negative and un-insured MSM. Focusing PEP programs on these men may potentially increase uptake. Increased knowledge needs to be provided to MSM who engage in risky sexual behaviors.