Knowledge of HIV post-exposure prophylaxis (PEP) is not associated with increase in sexual risk behaviour among men who have sex with men

Published: August 1, 2008

Knowledge of HIV post-exposure prophylaxis (PEP) is not associated with increase in sexual risk behaviour among men who have sex with men

Background: Concern is raised that promoting the use of PEP after HIV-related sexual risk incidents will increase the rate of risk taking among men who have sex with men (MSM). Our study investigated PEP knowledge, knowledge quality, PEP usage, and the association between PEP knowledge and increased levels of risk behaviour among MSM.

Methods: In 2006, 544 participants of the Amsterdam Cohort Studies among Homosexual Men (aged 35.4 SD=9.2), of whom 70 were HIV-positive, filled in questionnaires inquiring to their knowledge and uptake of PEP and sexual risk behavior with steady and casual partners. Logistic regression analyses were used to examine associations with risk.

Results: 69% (373/544) of the participants knew about PEP. Of those, 75% (280/373) knew correctly where PEP can be obtained, 64% (236/367) did not know correctly how long a PEP regimen lasts, and only 15% (54/369) knew that PEP can be started within 72 hours. Most importantly, 46% did not consider PEP effective in preventing an HIV infection. Of the 45 HIV-negative men who had unprotected anal intercourse (UAI) with casual partners, only 10% (4/42) considered PEP and none took it. Of the 50 HIV-negative men who had risky UAI with steady partners (i.e. UAI with a partner of unknown or discordant HIV-status), only 6% (3/50) considered PEP and one person took it. Analyses indicated that knowledge of PEP was not associated with increased risk taking with steady or casual partners, even when corrected for quality of knowledge and HIV status.

Conclusions: PEP knowledge was not associated with risk behavior among MSM and therefore the promotion of PEP should not be avoided. The uptake of PEP after risk incidents was extremely small and might be associated with the low quality of PEP knowledge. HIV-prevention should increase the uptake of PEP by improving the quality of PEP-knowledge.

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