Blood Safety, Hepatitis, STI and HIV Division, Public Health England, London, UK.
Sexual Health, Reproductive Health and HIV, Public Health England, London, UK.
BMC Public Health. 2022 Jun 3;22(1):1105. doi: 10.1186/s12889-022-13425-0.
Access to prevention options, including HIV pre-exposure prophylaxis (PrEP), remains a public health priority for gay, bisexual, and other men who have sex with men (MSM), especially in London. We describe PrEP use in a London community sample of MSM before the introduction of a national PrEP programme in October 2020.
From June-August 2019, MSM aged ≥ 18 recruited from London commercial venues were asked to self-complete a sexual health questionnaire and provide an oral fluid sample for anonymous HIV antibody testing. Descriptive analyses of demographic characteristics, service engagement and outcomes, as well as sexual risk and prevention behaviours were examined in the survey population and in those reporting current PrEP use. We performed sequential, multivariate analyses examining current PrEP use in MSM of self-perceived HIV-negative/unknown status with identified PrEP-need defined as the report of condomless anal sex (CAS) in the last three months, or the report of CAS (in the last year) with an HIV-positive/unknown status partner not known to be on HIV treatment, in reflection of UK PrEP guidelines.
One thousand five hundred and thirty-fifth questionnaires were completed across 34 venues, where 1408 were analysed. One in five MSM of self-perceived HIV-negative/unknown status reported current PrEP use (19.7%, 242/1230). In men with PrEP-need, 68.2% (431/632) did not report current use. Current PrEP use was associated with age (aOR: 3.52, 95% CI: 1.76-7.02 in men aged 40-44 vs men aged 18-25) and education (aOR: 1.72, 95% CI: 1.01-2.92 in men with ≥ 2 years/still full-time vs no/ < 2 years of education since age 16).
Among MSM in London, PrEP use is high but there is indication of unmet PrEP-need in men of younger age and lower levels of post-16 education. National programme monitoring and evaluation will require continued community monitoring to guide interventions ensuring equitable PrEP access and uptake in those who could most benefit from PrEP.
对于男同性恋、双性恋和其他与男性发生性关系的男性（MSM），包括艾滋病毒暴露前预防（PrEP）在内的预防措施的获取仍然是公共卫生的重点，在伦敦尤其如此。我们描述了 2020 年 10 月国家 PrEP 计划推出前，在伦敦社区 MSM 样本中 PrEP 的使用情况。
2019 年 6 月至 8 月，从伦敦商业场所招募年龄≥18 岁的 MSM，要求他们自行填写一份性健康问卷，并提供一份口腔液样本进行匿名艾滋病毒抗体检测。在调查人群和报告当前 PrEP 使用情况的人群中，对人口统计学特征、服务参与和结果，以及性行为风险和预防行为进行了描述性分析。我们进行了连续的多变量分析，以检查自我评估 HIV 阴性/未知状态的 MSM 中当前 PrEP 的使用情况，确定的 PrEP 需求定义为过去三个月内无保护肛交（CAS）的报告，或过去一年中 CAS（与 HIV 阳性/未知状态的伴侣）的报告，而伴侣未被认为正在接受 HIV 治疗，这反映了英国 PrEP 指南。
在 34 个场所共完成了 1535 份问卷，其中分析了 1408 份。五分之一的自我评估 HIV 阴性/未知状态的 MSM 报告当前正在使用 PrEP（19.7%，242/1230）。在有 PrEP 需求的男性中，68.2%（431/632）没有报告当前使用。当前 PrEP 的使用与年龄（aOR：3.52，95%CI：18-25 岁男性 vs 40-44 岁男性）和教育程度（aOR：1.72，95%CI：101-2.92 岁男性 vs 16 岁以后有≥2 年/仍全职教育 vs 没有/＜16 岁以后有 2 年教育）相关。
在伦敦的 MSM 中，PrEP 的使用率很高，但在年龄较小和接受过 16 岁以后教育程度较低的男性中，PrEP 的需求仍未得到满足。国家方案监测和评估将需要持续进行社区监测，以指导干预措施，确保那些最能从 PrEP 中受益的人能够公平地获得和使用 PrEP。
