The Kirby Institute, UNSW Sydney, Sydney, Australia.
Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia.
J Acquir Immune Defic Syndr. 2019 Jul 1;81(3):e73-e84. doi: 10.1097/QAI.0000000000002047.
HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention strategy, yet some gay and bisexual men (GBM) who are eligible to access PrEP are not using it. We report the incidence of PrEP uptake, factors predicting its initiation, and identify characteristics associated with nonuptake of PrEP among Australian GBM who meet the eligibility criteria.
The Following Lives Undergoing Change (Flux) Study is a national, online, prospective observational study among GBM focusing on licit and illicit drug use. Participants (N = 1257) responded to baseline and 6-monthly follow-up questionnaires. Incidence per 100 person-years and incidence rate ratios of PrEP initiation are presented. Multivariate Poisson regression was used to examine associations with PrEP initiation and logistic regression to examine associations with nonuptake of PrEP among eligible GBM.
Among GBM who met the eligibility criteria, 69.8% of men did not commence PrEP. Factors independently associated with nonuptake of PrEP were younger age, living in an Australian state without a PrEP trial, lower social engagement with other gay men, less use of illicit party drugs or use of illicit party drugs for sex, and less likely to have engaged in HIV sexual risk behaviors such as group sex or any condomless anal intercourse.
Despite meeting formal eligibility criteria for PrEP, men who were relatively less sexually active or less socially connected were less likely to initiate PrEP. Men who did not initiate PrEP may assess their risk as insufficient relative to others to warrant using PrEP because they engaged in less frequent "risky" behaviors.
HIV 暴露前预防（PrEP）是一种高效的医学预防 HIV 的策略，但有些符合 PrEP 使用条件的男同性恋和双性恋者（GBM）并未使用 PrEP。我们报告了澳大利亚 GBM 中符合 PrEP 使用条件者的 PrEP 使用率、预测其开始使用的因素，以及确定与未使用 PrEP 相关的特征。
正在进行的“变革中的生活”（Flux）研究是一项针对 GBM 的全国性、在线、前瞻性观察性研究，重点关注合法和非法药物的使用。参与者（N=1257）回答了基线和 6 个月的随访问卷。以每 100 人年的发生率和 PrEP 开始的发生率比来表示。多变量泊松回归用于检查与 PrEP 开始相关的因素，逻辑回归用于检查符合条件的 GBM 中与未使用 PrEP 相关的因素。
在符合 PrEP 使用条件的 GBM 中，69.8%的男性未开始使用 PrEP。与未使用 PrEP 相关的独立因素包括年龄较小、居住在没有 PrEP 试验的澳大利亚州、与其他男同性恋者社交参与度较低、较少使用非法派对药物或使用非法派对药物进行性行为，以及较少进行 HIV 性风险行为，如群交或任何无保护的肛交。
尽管符合 PrEP 使用的正式资格标准，但相对较少有性行为或社交较少的男性不太可能开始使用 PrEP。未开始使用 PrEP 的男性可能认为自己的风险相对较低，不需要使用 PrEP，因为他们参与的“风险”行为频率较低。
