Knowledge and use of post-exposure prophylaxis among at-risk Boston men who have sex with men: implications for other biological prevention interventions
K. Mayer1,2, M. Mimiaga1,3, C. Johnson1, P. Case1, S. Safren1,3
1Fenway Health, The Fenway Institute, Boston, United States, 2Brown Medical School/Miriam Hospital, Infectious Diseaes, Providence, United States, 3Massachusetts General Hospital/Harvard Medical School, Psychiatry, Boston, United States
Background: Understanding the factors associated with high risk men who have sex with men´s (MSM) knowledge and use of post-exposure prophylaxis (PEP) may be helpful as other biomedical interventions (e.g. PrEP, microbicides) become available.
Methods: A community-based sample of 227 at-risk HIV-uninfected, Boston MSM recruited by modified-respondent-driven sampling completed an interviewer-administered questionnaire asking about demographics, sexual and substance use behaviors, as well as knowledge, attitudes and experience regarding different HIV prevention approaches. Logistic regression procedures examined the factors associated with PEP knowledge and use.
Results: Participants’ mean age was 41 (SD=9.1); 54% were non-white. Although 28.2% reported awareness of PEP, only 3.1% had used it. Prior PEP users did not differ from non-users demographically, but were more likely to use poppers (p=0.043), GHB (p< 0.0001), ketamine (p=0.0001), and methamphetamine (p=0.031). Men who had heard of PEP were more likely to be Caucasian (p=0.031), more educated (p< 0.0001), and use cocaine (p=0.0096) or methamphetamine (p=0.0195). Prior PEP users were more likely to have heard of PrEP (p< 0.0001) and those who had heard of PEP had more favorable attitudes towards PrEP use (p< 0.0001). Almost one-quarter of the men (24.7%) met sex partners online, and were more likely to have heard of PEP (p=0.0052) or PrEP (p< 0.0001), and have more favorable attitudes about PrEP (p=0.0181) than those who did not meet partners online.
Conclusions: The majority of Boston MSM had not heard of or used PEP, but those who had tended to be more educated, more likely to use non-prescription drugs, and use the internet to meet sex partners. Programs to increase PEP uptake by at-risk MSM may be enhanced by educational messaging on the internet, but will also need to address less educated and minority MSM. These educational strategies may transfer to PrEP if or when efficacy is demonstrated.