Hulstein Sebastiaan H, Matser Amy, van der Loeff Maarten F Schim, Hoornenborg Elske, Prins Maria, de Vries Henry J C
From the Department of Infectious Diseases, Public Health Service of Amsterdam.
Sex Transm Dis. 2021 Feb 1;48(2):86-93. doi: 10.1097/OLQ.0000000000001291.
Before 2019, availability of affordable HIV preexposure prophylaxis (PrEP) was limited in the Netherlands. Consequently, some men who have sex with men and transgender persons obtained PrEP informally, that is, without a prescription.
Between September 2017 and August 2018, we enrolled informal PrEP users in a cohort study (Informal PrEP [InPrEP]) at the Amsterdam Sexually Transmitted Infections (STI) Clinic. We compared PrEP use, PrEP eligibility and intention, chemsex, and STI positivity between 3 groups: (1) informal PrEP users enrolled in InPrEP, (2) nonenrolled informal PrEP users, and (3) non-PrEP users. Also, we assessed intention and associated characteristics among non-PrEP users who were eligible for PrEP.
During the study period, we enrolled 118 informal PrEP users in InPrEP who were compared with 224 nonenrolled informal PrEP users and 4975 non-PrEP users. Preexposure prophylaxis eligibility rates were 83.1%, 93.4%, and 63.0%; chemsex were reported by 39.1%, 48.1%, and 11.7%; and STI positivity was reported by 28.0%, 42.5%, and 20.3%, respectively. Among PrEP-eligible non-PrEP users, PrEP intention was 16.6% and associated with increasing age, non-Dutch origin, higher educational level, receptive condomless anal sex, increasing number of sex partners, chemsex, and sex with men only.
Most informal PrEP users are eligible to use PrEP and have a clear sexual health care need. Especially in settings with limited PrEP access, providing the necessary care for informal PrEP users is important. The intention to use PrEP is low among PrEP-eligible STI clinic visitors. Further research should investigate modes to increase PrEP intention among PrEP-eligible persons.
2019年之前，荷兰可负担得起的艾滋病病毒暴露前预防（PrEP）药物供应有限。因此，一些男男性行为者和跨性别者通过非正式途径获取PrEP，即无处方获取。
2017年9月至2018年8月期间，我们在阿姆斯特丹性传播感染（STI）诊所将非正式PrEP使用者纳入一项队列研究（非正式PrEP [InPrEP]）。我们比较了三组之间的PrEP使用情况、PrEP适用资格和意愿、化学性行为以及性传播感染阳性情况：（1）纳入InPrEP的非正式PrEP使用者，（2）未纳入的非正式PrEP使用者，以及（3）非PrEP使用者。此外，我们评估了符合PrEP使用资格的非PrEP使用者的意愿及相关特征。
在研究期间，我们将118名非正式PrEP使用者纳入InPrEP，并与224名未纳入的非正式PrEP使用者和4975名非PrEP使用者进行比较。暴露前预防适用率分别为83.1%、93.4%和63.0%；报告有化学性行为的比例分别为39.1%、48.1%和11.7%；报告有性传播感染阳性的比例分别为28.0%、42.5%和20.3%。在符合PrEP使用资格的非PrEP使用者中，PrEP使用意愿为16.6%，且与年龄增长、非荷兰裔、教育水平较高、接受无保护肛交、性伴侣数量增加、化学性行为以及仅与男性发生性行为有关。
大多数非正式PrEP使用者有资格使用PrEP，并且有明确的性健康护理需求。尤其是在PrEP获取有限的情况下，为非正式PrEP使用者提供必要的护理很重要。在符合PrEP使用资格的性传播感染诊所就诊者中，PrEP使用意愿较低。进一步的研究应调查提高符合PrEP使用资格者PrEP使用意愿的方式。
