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Influence of potential symptoms and perceived efficacy on the willingness to use HIV Pre-Exposure Prophylaxis (PrEP) among Boston area men who have sex with men (MSM)
K. Mayer1,2, C. Johnson1, M. Mimiaga1,3, S. Safren1,3, P. Case1
1Fenway Health, The Fenway Institute, Boston, United States, 2Brown University, Medicine and Community Health, Providence, United States, 3Harvard Medical School, Psychiatry, Boston, United States
Background: Data from PrEP clinical trials will be available soon, but ultimate effectiveness in preventing HIV transmission will be influenced by perceptions about efficacy and tolerability, affecting drug utilization and adherence.
Methods: In 2007, 227 HIV-uninfected high risk MSM, recruited by modified respondent-driven sampling, completed an interviewer-administered survey assessing prior PrEP experience, knowledge, intentions regarding future use, anticipated symptoms, as well as behavioral and socio-demographic variables. Chi square tests and ANOVA's were performed to assess associations of perceived efficacy and side effects regarding intent to use PrEP.
Results: Participants' mean age was 41 (SD = 9.1); 54% were non-white. Only one participant had used PrEP; 19% had heard of PrEP for HIV prevention. Forty-two percent initially indicated that they would not likely use PrEP because of concerns about side effects. This did not significantly differ by race/ethnicity, educational status or recent risky sex. Nitrite inhalant (“popper”) users were more concerned by potential symptoms than other substance users (p< 0.05). Willingness to use PrEP was directly associated with perceived efficacy (p< 0.0001); 76% felt that PrEP would have to be more than 80% effective in order to use it during unprotected anal sex. Seventy-four percent were willing to consider using PrEP if it was less than 100% effective and there were only mild side effects; in contrast, only 32% would consider using it if perceived symptoms were severe (p< 0.0001). Mild fatigue, diarrhea, or headache were associated with less negative attitudes regarding potential PrEP use compared to myalgias, nausea, or facial or body changes (p< 0.0001).
Conclusions: High risk Boston MSM have recently had little PrEP experience. Once data from PrEP clinical trials are available, a major program of community education will be needed to address concerns about potential side effects and efficacy, which could affect PrEP utilization among at risk MSM.
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