The characteristics of men who have sex with men (MSM) using post-exposure prophylaxis for sexual exposure (PEPSE) in the pre-exposure prophylaxis (PrEP) era.

Abstract

HIV pre-exposure prophylaxis (PrEP) is now available in the UK. However, some men who have sex with men (MSM) continue to use HIV post-exposure prophylaxis following sexual exposure (PEPSE) and are not using PrEP. It is important to characterize MSM having condomless anal sex who are not using PrEP. In a cross-sectional analysis, we compared the characteristics of MSM who used PEPSE in 2021 with MSM using PEPSE in 2017. Overall, 126MSM used PEPSE in January to June 2017 and 28MSM used PEPSE in January to June 2021, a 78% decline in PEPSE use. Those MSM using PEPSE in 2021 were significantly younger (27 vs. 35years, p<0.01), more likely to identify as black or from another minority ethnic group [29% (8/28) vs. 8% (10/126); p<0.01], more likely to attend as a result of a group sex encounter [35% (10/28) vs. 16% (10/126); p=0.03], more likely to attend following sex involving recreational drug use [32% (9/28) vs. 13% (16/126); p=0.02], and more likely to initiate PEPSE in the emergency department [35% (10/28) vs. 19% (24/126); p=0.04] compared with MSM attending in 2017. Those MSM using PEPSE in 2021 were significantly less likely to attend follow-up appointments compared with the 2017 cohort [71% (20/28) vs. 87% (110/126); p<0.05]. Ninety-five per cent of MSM using PEPSE in 2021 were initiated on PrEP at follow-up. Despite PrEP being readily available, some MSM continue using PEPSE and these MSM are significantly more likely to be younger, from black or minority ethnic groups, to engage in group sex involving recreational drugs and to attend the emergency department for PEPSE compared with MSM attending in 2017. Increasing the accessibility of PrEP for this group of MSM is important in order to optimize HIV prevention strategies.