Frankis Jamie, Young Ingrid, Flowers Paul, McDaid Lisa
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.
PLoS One. 2016 Apr 19;11(4):e0151385. doi: 10.1371/journal.pone.0151385. eCollection 2016.
Recent clinical trials suggest that pre-exposure prophylaxis (PrEP) may reduce HIV transmission by up to 86% for men who have sex with men (MSM), whilst relatively high levels of PrEP acceptability have been reported to date. This study examines PrEP awareness amongst sub-groups of MSM communities and acceptability amongst MSM in a low prevalence region (Scotland, UK), using a mixed methods design.
Quantitative surveys of n = 690 MSM recruited online via social and sociosexual media were analysed using descriptive statistics and multivariate logistic regression. In addition, n = 10 in-depth qualitative interviews with MSM were analysed thematically.
Under one third (29.7%) of MSM had heard of PrEP, with awareness related to living in large cities, degree level education, commercial gay scene use and reporting an HIV test in the last year. Just under half of participants (47.8%) were likely to use PrEP if it were available but there was no relationship between PrEP acceptability and previous PrEP awareness. Younger men (18-25 years) and those who report higher risk UAI were significantly more likely to say they would use PrEP. Qualitative data described specific PrEP scenarios, illustrating how risk, patterns of sexual practice and social relationships could affect motivation for and nature of PrEP use.
These findings suggest substantial interest PrEP amongst MSM reporting HIV risk behaviours in Scotland. Given the Proud results, there is a strong case to investigate PrEP implementation within the UK. However, it appears that disparities in awareness have already emerged along traditional indicators of inequality. Our research identifies the need for comprehensive support when PrEP is introduced, including a key online component, to ensure equity of awareness across diverse MSM communities (e.g. by geography, education, gay scene use and HIV proximity), as well as to responding to the diverse informational and sexual health needs of all MSM communities.
近期临床试验表明，暴露前预防（PrEP）可使男男性行为者（MSM）的HIV传播率降低多达86%，而且迄今为止报告的PrEP可接受水平相对较高。本研究采用混合方法设计，调查了英国低流行地区（苏格兰）MSM社区亚组中的PrEP知晓情况以及MSM群体中的可接受性。
对通过社交和性取向社交网络在线招募的690名MSM进行定量调查，采用描述性统计和多变量逻辑回归分析。此外，对10名MSM进行了深入的定性访谈，并进行了主题分析。
不到三分之一（29.7%）的MSM听说过PrEP，知晓情况与居住在大城市、受过高等教育、参与商业同性恋活动以及去年接受过HIV检测有关。如果有PrEP，近一半的参与者（47.8%）可能会使用，但PrEP的可接受性与之前对PrEP的知晓情况无关。较年轻的男性（18 - 25岁）以及报告有较高风险的无保护肛交行为的男性表示更有可能使用PrEP。定性数据描述了特定的PrEP场景，说明了风险、性行为模式和社会关系如何影响PrEP使用的动机和性质。
这些研究结果表明，在苏格兰报告有HIV风险行为的MSM群体中，对PrEP有相当大的兴趣。鉴于“骄傲”项目的结果，有充分理由在英国调查PrEP的实施情况。然而，似乎在不平等的传统指标方面已经出现了知晓情况的差异。我们的研究表明，在引入PrEP时需要全面的支持，包括关键的在线部分，以确保不同MSM社区（如按地理位置、教育程度、参与同性恋活动情况和与HIV的关联程度）的知晓情况公平，同时满足所有MSM社区多样化的信息和性健康需求。
