Reasons for not Using HIV Pre-Exposure Prophylaxis (PrEP) among Gay and Bisexual Men in Australia: Mixed-Methods Analyses from a National, Online, Observational Study

Abstract

Although approximately 31,000 Australian gay and bisexual men (GBM) are eligible for HIV pre-exposure prophylaxis (PrEP), only 18,500 people currently use it, indicating a need to investigate why GBM do not use it. This article uses data from a national, online, observational study. It adopts a mixed-methods analysis to responses to survey questions asking about reasons Australian GBM were not using PrEP in 2018, according to their level of HIV risk as delineated by the Australian PrEP prescribing guidelines at the time. Participants responded to check-box questions and had the option to respond to a qualitative free-text question. Results showed that just over one-fifth of men were at higher risk of HIV acquisition. Compared to lower-risk men, higher-risk men were more likely to indicate PrEP was too expensive and more likely to cite embarrassment asking for it. Reasons for not using PrEP included a lack of personal relevance, poor accessibility or knowledge, concerns about PrEP’s inability to protect against STIs, potential side effects, and a preference for condoms. We conclude that health promotion more effectively targeting GBM who may benefit the most from PrEP may be valuable.

Keywords:

• Australia
• gay and bisexual men
• PrEP
• quantitative
• qualitative
• uptake

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical statement

Ethics approval was provided by the Human Research Ethics Committee of UNSW Sydney (HC14075). All study participants provided informed online written consent.

Additional information

Funding

This study was funded by the Australian Research Council (ARC), ARC Grant number: DP140102483, and by a Gilead Research Fellowship. The research centers involved in this project receive funding from the Australian Government Department of Health. Two authors are supported by National Health and Medical Research Council Fellowships.