From the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University of Bristol, University Hospitals Bristol NHS Foundation Trust.
Cardiff and Vale Sexual Health Service, Cardiff.
Sex Transm Dis. 2021 Sep 1;48(9):685-692. doi: 10.1097/OLQ.0000000000001384.
Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has helped reduce new HIV infections. However, bacterial sexually transmitted infections (STIs) have increased among PrEP users. We examined PrEP knowledge, access, and risk perceptions in an age of antimicrobial resistance (AMR).
An online anonymous survey was distributed to all cisgender men/transpersons who have sex with men attending a sexual health clinic in Bristol, United Kingdom (October 2018 to November 2019). Interviews with a sample identified at increased risk of HIV were analyzed thematically and integrated with survey data.
Five hundred and seventy-eight (95%) of 617 cisgender men/transpersons who have sex with men survey respondents were HIV-negative/unknown, of these, 202 (34.9%) had ever used PrEP. Interviewees (n = 24) reported widespread awareness of and enthusiasm for PrEP. Among nonusers, 39% (146/376) were unaware how to access PrEP, and 27% (103/376) could not access PrEP through the national "impact" trial of whom 79% (81/103) were eligible. The PrEP was described as "life-changing," but expense was the main barrier to use. Sixty-two percent (358/578) of HIV-negative/unknown respondents on PrEP were more likely to have condomless anal intercourse with someone they thought was HIV-negative. Interviewees used PrEP with other risk-reduction strategies. Sexually transmitted infections were seen as "curable" and AMR rarely influenced risk perception or sexual decision making.
The PrEP awareness was high, but purchase cost limited access. PrEP may increase condomless anal intercourse, but interviewees used PrEP as one of many risk-reduction tools. Reduced fear of HIV transmission and testing was highly valued. Sexually transmitted infection AMR was not seen as an immediate threat and did not influence risk perception or sexual decision making.
人类免疫缺陷病毒（HIV）暴露前预防（PrEP）有助于减少新的 HIV 感染。然而，在抗微生物药物耐药性（AMR）时代，PrEP 用户的细菌性性传播感染（STI）有所增加。我们在 AMR 时代检查了 PrEP 知识、获取途径和风险认知。
我们向英国布里斯托尔性健康诊所就诊的所有跨性别男性/跨性别者（男男性行为者）中的顺性别男性/跨性别者（男男性行为者）分发了一份在线匿名调查。对确定为 HIV 感染风险较高的样本进行了访谈，进行了主题分析，并与调查数据相结合。
617 名顺性别男性/跨性别者（男男性行为者）中的 578 名（95%）HIV 阴性/未知，其中 202 名（34.9%）曾使用过 PrEP。受访者（n=24）广泛了解并热衷于 PrEP。在非使用者中，39%（146/376）不知道如何获取 PrEP，27%（103/376）无法通过国家“影响”试验获取 PrEP，其中 79%（81/103）符合条件。PrEP 被描述为“改变生活”，但费用是使用的主要障碍。578 名 HIV 阴性/未知的 PrEP 使用者中，62%（358/578）更有可能与他们认为 HIV 阴性的人进行无保护的肛交。受访者使用 PrEP 与其他降低风险的策略。性传播感染被视为“可治愈”，AMR 很少影响风险认知或性决策。
PrEP 意识很高，但购买成本限制了获取途径。PrEP 可能会增加无保护的肛交，但受访者将 PrEP 用作许多降低风险的工具之一。对 HIV 传播和检测的恐惧降低受到高度重视。性传播感染的 AMR 并未被视为迫在眉睫的威胁，也未影响风险认知或性决策。
