When awareness is not a barrier to PrEP uptake among men who have sex with men who are eligible for PrEP in France

ABSTRACT

Despite PrEP being available and free of charge in France, a gap remains between the estimated number of men who have sex with men (MSM) with high-risk exposure to HIV and the number of MSM PrEP users. The objective of this study is to identify factors associated with non-intention to use PrEP among PrEP-eligible and PrEP-aware MSM in France, “non-intenders”.

European MSM Internet Survey (EMIS)-2017 was a cross-sectional survey conducted among MSM concerning their HIV prevention needs. Logistic regression models were used to identify factors associated with “non-intenders”.

Compared to PrEP users, factors associated with non-intention to use PrEP were: age (aOR[95%CI] = 3.80[2.21;6.53]); not being vaccinated against hepatitis B (2.20[1.45;3.34]); self-efficacy (1.84[1.29;2.60]); lower knowledge about on-demand PrEP (11.48[7.37;17.87]) and daily PrEP (2.58[1.27;5.25]); not having a PrEP discussion at a hospital (12.39[8.90;17.27]) or at a community service/drop-in (4.93[3.48;6.97]); living in a department with few PrEP access points (1.70[1.10;2.63]).

On-demand PrEP may meet the prevention needs of “non-intenders” who have lower HIV risk perception. Increasing communication from health providers and community health workers to all MSM is needed.

KEYWORDS:

• PrEP
• MSM
• Europe
• non-intention

Acknowledgements

We begin by thanking all of the men who took part in EMIS-2017. EMIS-2017 is coordinated by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. EMIS core team @ Sigma Research (LSHTM): Dr Axel J. Schmidt, Dr Ford Hickson; David Reid, and Peter Weatherburn; in association with Dr Ulrich Marcus and Susanne B. Schink @ RKI. We thank all our partners for being part of something huge. The following list acknowledges all partners in EMIS by country. Individual names are mentioned if a freelancer was the main contact and/or translator or where input on the questionnaire development came from a person not formally representing anorganisation. The order (if available) is: main NGO partner, other NGO partners, academic partners, governmental partners, individuals. Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). FR: AIDES, Coalition PLUS, SexoSafe, Santé Publique France, INSERM.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Consent for publication

Not applicable.

Availability of data and materials

All data concerning the present analysis are available in the Tables.

Competing interest

No potential conflict of interest was reported by the author(s).

Ethics approval and consent to participate

EMIS-2017 received a favourable ethical opinion from the Observation Research Ethics Committee at the London School of Hygiene and Tropical Medicine (review reference 14421 /RR/8805) on 31 July 2017.

Informed consent has been obtained for all participants.

All methods were carried out in accordance with relevant guidelines and regulations.

Authors’ contributions

DRC, AV AJS, DM and SM designed the study and data collection tool. VV and TA performed statistical analysis. MD and RD identified research question, supervised the analysis and wrote the paper.

Europe

PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). France: AIDES, Coalition PLUS, SexoSafe, Santé Publique France, INSERM.

Additional information

Funding

EMIS-2017 was carried out as part of ESTICOM, under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. The contract arises from the Call for tender No Chafea/2015/Health/38.