|Authors||Cambiano V., Sewell J., Speakman A., Phillips A.N., Lampe F.C., Gilson R., Asboe D., Nwokolo N., Clarke A., Collins S., Rodger A.J. |
Background: Pre-exposure prophylaxis (PrEP) is not yet available in England through the National Health Service (NHS). However, it is legal to buy and import PrEP for personal use. We describe the use of PrEP and post-exposure prophylaxis (PEP) over time in gay/bisexual men attending sexual health clinics.
Methods: AURAH2 (Attitudes to and Understanding of Risk of Acquisition of HIV over time) is a longitudinal study that enrolled gay/bisexual men from three sexual health clinics in England. Participants self-completed a questionnaire at enrolment and subsequent 4 monthly web-based questionnaires on socio-demographics, sexual behaviours, recreational drug use, and PrEP and PEP use at the annual questionnaire.
Results: 1167 men completed a baseline questionnaire (7/2013-4/2016), 620 subsequently completed an online questionnaire and 467 men provided 668 annual questionnaires 7/2015-7/2017).
At enrolment 72%(842/1167) of participants were aware of PrEP and 6%(65/1167) had ever taken it. Proportions increased over time: awareness from 43%(12/28) in quarter3 and quarter4 of 2013 (2013Q3Q4) to 92%(58/63) in 2016Q2, ever use from < 5%(1/28) in 2013Q3Q4 to 11%(7/63) in 2016Q2. On the other hand, awareness of PEP was already high (93%,26/28, in 2013Q3Q4) and remained so (97%,61/63 in 2016Q2), but ever use of PEP doubled: from 21%(6/28) in 2013Q3Q4 to 49%(31/63) in 2016Q2.
In the annual questionnaires, similar levels of PEP and PrEP use in the previous 12 months were reported in 2015Q3Q4 (12%,12/99 for PrEP, 11%,11/99 for PEP) and they both peaked in 2017Q1 (25%,19/76 for PrEP, 25%,19/76 for PEP).
Among men who reported PrEP in the last 12 months (n=110): 56% obtained it at least once from the internet and 46% from the clinic; 50% reported using PrEP or condoms with all men they had sex with.
[Figure 1. PrEP and PEP awareness, ever use and use in the last 12 months]
Conclusions: PrEP awareness has increased substantially since 2013 and its use is increasing despite not being available through the NHS.