Richardson Daniel, Nichols Kayleigh, Hughes Richard, Smith Hannah, Fitzpatrick Colin, Cresswell Fiona
University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
Brighton & Sussex Medical School, Brighton, UK.
HIV Med. 2022 May;23(5):553-557. doi: 10.1111/hiv.13201. Epub 2021 Nov 2.
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, 126 MSM used PEPSE in January to June 2017 and 28 MSM used PEPSE in January to June 2021, a 78% decline in PEPSE use. Those MSM using PEPSE in 2021 were significantly younger (27 vs. 35 years, 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.
暴露前预防（PrEP）目前在英国已可获得。然而，一些男男性行为者（MSM）在性暴露后仍继续使用暴露后预防（PEPSE），而未使用PrEP。了解未使用PrEP且有无保护肛交行为的男男性行为者的特征很重要。
在一项横断面分析中，我们比较了2021年使用PEPSE的男男性行为者与2017年使用PEPSE的男男性行为者的特征。
总体而言，2017年1月至6月有126名男男性行为者使用PEPSE，2021年1月至6月有28名男男性行为者使用PEPSE，PEPSE的使用量下降了78%。2021年使用PEPSE的男男性行为者明显更年轻（27岁对35岁，p<0.01），更有可能认定自己为黑人或属于其他少数族裔群体[29%（8/28）对8%（10/126）；p<0.01]，因群交而前来就诊的可能性更大[35%（10/28）对16%（10/126）；p=0.03]，在涉及使用消遣性药物的性行为后前来就诊的可能性更大[32%（9/28）对13%（16/126）；p=0.02]，并且与2017年前来就诊的男男性行为者相比，在急诊科开始使用PEPSE的可能性更大[35%（10/28）对19%（24/126）；p=0.04]。与2017年的队列相比，2021年使用PEPSE的男男性行为者进行随访预约的可能性明显更低[71%（20/28）对87%（110/126）；p<0.05]。2021年使用PEPSE的男男性行为者中有95%在随访时开始使用PrEP。
尽管PrEP已容易获得，但一些男男性行为者仍继续使用PEPSE，与2017年前来就诊的男男性行为者相比，这些男男性行为者明显更年轻，来自黑人或少数族裔群体，参与涉及消遣性药物的群交，并且因PEPSE而前往急诊科就诊。提高这一群男男性行为者获得PrEP的可及性对于优化艾滋病毒预防策略很重要。
