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

Figures & data

Table 1. Description and comparison of sociodemographic characteristics, sexual behaviours, HIV testing, HIV prevention knowledge, and access to health care of “non-intenders” and PrEP users among EMIS-2017 respondents living in France, N = 1,832.

	“Non-intenders”	PrEP users		Total
	% (n)	% (n)	P-value	% (n)
	n = 1,098	n = 734		n = 1,832
Sociodemographic characteristics
Age (in years)			<0.001
< 25  25–34  35–44	19.2 (211) 29.5 (324) 24.3 (267)	5.6 (41) 32.3 (237) 32.7 (240)		13.8 (252) 30.6 (561) 27.7 (507)
≥ 45	27.0 (296)	29.4 (216)		27.9 (512)
Number of years spent in full-time education since the age of 16			0.078
0–4 years	24.1 (253)	19.6 (139)		22.3 (392)
5–6 years	23.8 (250)	26.0 (184)		24.7 (434)
7 years or more	52.1 (546)	54.4 (386)		53.0 (932)
Employment situation			<0.001
Employed	72.1 (790)	82.1 (602)		76.1 (1392)
Unemployed	8.9 (98)	6.7 (49)		8.1 (147)
Student	14.0 (153)	5.3 (39)		10.5 (192)
Retired/Sickness leave/Others	5.0 (54)	5.9 (43)		5.3 (97)
Financial coping			0.557
Really comfortable to neither comfortable nor struggling	83.8 (918)	84.9 (622)		84.2 (1540)
Really struggling/Struggling	16.2 (177)	15.1 (111)		15.8 (288)
Settlement size			<0.001
Small town (<100,000) or village	33.9 (368)	25.3 (183)		30.5 (551)
Medium (100,000+) or big city	66.1 (717)	74.7 (541)		69.5 (258)
Region of residence			<0.001
Île-de-France (Paris Region)	29.7 (316)	41.9 (298)		34.6 (614)
Provence-Alpes-Côte-D’Azur with Corse	10.1 (107)	9.7 (69)		9.9 (176)
Auvergne-Rhône-Alpes	12.2 (130)	12.9 (92)		12.5 (222)
Occitania	10.5 (112)	8.2 (58)		9.6 (170)
Other French Regions	37.5 (399)	27.3 (194)		33.4 (593)
Relationship status			0.281
Single	59.2 (650)	59.0 (432)		59.2 (1082)
Steady Partner	33.1 (363)	35.1 (257)		33.9 (620)
Not sure/complicated	7.7 (84)	5.9 (43)		6.9 (127)
Sexual identity			<0.001
Gay or Homosexual	83.1 (911)	90.9 (667)		86.2 (1578)
Bisexual	10.0 (110)	5.2 (38)		8.1 (148)
Other	6.9 (75)	3.9 (29)		5.7 (104)
Sexual Behaviours
Number of anal intercourse non-steady male partners in the previous 12 months			<0.001
1	6.2 (63)	2.1(14)		4.5 (77)
2–9	45.1 (460)	19.6 (134)		34.9 (594)
10 or more	48.7 (497)	78.3 (534)		60.6 (1031)
Frequency of condom use for anal intercourse with non-steady male partners in the last 12 months			<0.001
Never/Seldom/sometimes	24.1 (262)	56.9 (414)		37.3 (676)
Mostly/always	69.6 (757)	36.9 (268)		56.5 (1025)
Not concerned	6.3 (68)	6.2 (45)		6.2 (113)
Use of stimulants for sex (“Chemsex”) in the previous 12 months			<0.001
Yes	27.3 (299)	36.0 (263)		30.8 (562)
No	72.7 (796)	64.0 (468)		69.2 (1264)
Level of outness			<0.001
Low	16.9 (185)	9.7 (71)		14.0 (256)
Medium/high	83.1 (912)	90.3 (659)		86.0 (1571)
Self-efficacy (“The sex I have is always as safe as I want it to be”/ “I find it easy to say “no” to sex I don’t want”)			<0.001
Disagree at least once	20.6 (226)	28.6 (210)		23.8 (436)
Never disagree	79.4 (872)	71.4 (524)		76.2 (1396)
Hepatitis vaccination history
Vaccinated against hepatitis A			<0.001
Yes	38.0 (416)	74.7 (547)		52.7 (963)
No	41.7 (457)	21.1 (154)		33.4 (611)
I don’t know	20.3 (223)	4.2 (31)		13.9 (254)
Vaccinated against hepatitis B			<0.001
Yes	58.3 (639)	86.9 (637)		69.8 (1276)
No	26.6 (291)	9.8 (72)		19.8 (363)
I don’t know	15.1 (166)	3.3 (24)		10.4 (190)
HIV testing and HIV prevention knowledge
Last HIV test result within the previous 6 months			<0.001
Yes	72.9 (742)	97.3 (697)		83.0 (1439)
No	27.1 (276)	2.7 (19)		17.0 (295)
Prior knowledge on “undetectable = untransmittable”			<0.001
Yes	64.4 (707)	90.9 (667)		75.0 (1374)
No	35.6 (390)	9.1 (67)		25.0 (457)
Prior knowledge on the possibility of event-based PrEP dosing ^(1)			<0.001
Yes	34.0 (372)	94.5 (692)		58.2 (1064)
No	66.0 (723)	5.5 (40)		41.8 (763)
Prior knowledge on the possibility of event based PrEP taking ^(2)			<0.001
Yes	77.3 (847)	98.6 (720)		85.8 (1567)
No	22.7 (249)	1.4 (10)		14.2 (259)
Prior knowledge on daily PrEP ^(3)			<0.001
Yes	63.3 (695)	98.0 (717)		77.2 (1412)
No	36.7 (403)	2.0 (15)		22.8 (418)
Access to PrEP
Health professional has spoken personally about PrEP			<0.001
Yes	21.5 (235)	90.3 (662)		49.1 (897)
No/don't know	78.5 (860)	9.7 (71)		50.9 (931)
Spoken personally about PrEP at a hospital or clinic as an out-patient			<0.001
Yes	8.8 (96)	62.0 (454)		30.1 (550)
No	91.2 (999)	38.0 (278)		69.9 (1277)
Spoken personally about PrEP at a community service or drop-in			<0.001
Yes	10.3 (113)	37.2 (272)		21.1 (385)
No	89.7 (982)	62.8 (460)		78.9 (1442)
Number of PrEP access points within department of residence			<0.001
0–1 access point	26.7 (283)	15.9 (113)		22.4 (396)
2–9 access points	50.6 (536)	52.1 (369)		51.2 (905)
10 access points and more	22.7 (241)	32.0 (227)		26.4 (468)

⁽¹⁾ “If someone knows in advance when they will have sex, PrEP needs to be taken as a double dose approximately 24 h before sex and then at both 24 and 48 h after the double dose”.

⁽²⁾ “Pre-Exposure prophylaxis (PrEP) involves someone who does not have HIV taking pills before as well as after sex to prevent them getting HIV”.

⁽³⁾ “PrEP can be taken as a single daily pill if someone does not know in advance when they will have sex”.

Table 2. Factors associated with belonging to the “non-intenders” group versus PrEP users, univariable (N = 1,832) and multivariable model (N = 1,757).

	Univariable Model (N = 1,832)			Multivariable Model (N = 1,757)
	OR [95%CI]	P-value		aOR [95%CI]	P-value
Sociodemographic characteristics
Age (in years)
< 25  25–34  35–44	3.76 [2.57;5.48] 1.00 [0.78;1.27] 0.81 [0.63;1.04]	<0.001 0.985 0.098		3.80 [2.21;6.53] 1.42 [0.97;2.09] 1.00 [0.67;1.47]	<0.001 0.074 0.981
≥ 45	1.00			1.00
Number of years spent in full-time education since the age of 16
0–4 years	1.29 [1.01;1.64]	0.043
5–6 years	0.96 [0.76;1.21]	0.732
7 years or more	1.00
Employment situation
Employed	1.00
Unemployed	1.52 [1.06;2.18]	0.021
Student	2.99 [2.07;4.32]	<0.001
Retired /Sickness leave/Others	0.96 [0.63;1.45]	0.835
Settlement size
Small town (<100,000) or village	1.52 [1.23;1.87]	<0.001
Medium (100,000+) or big city	1.00
Region of residence
Île-de-France (Paris Region)	1.00
Provence-Alpes-Côte-D’Azur with Corse	1.46 [1.04;2.06]	0.029
Auvergne-Rhône-Alpes	1.33 [0.98;1.82]	0.070
Occitania	1.82 [1.28;2.60]	0.001
Other French Regions	1.94 [1.54;2.45]	<0.001
Sexual identity
Gay or Homosexual	1.00
Bisexual	2.12 [1.45;3.11]	<0.001
Other	1.89 [1.22;2.94]	0.004
Sexual Behaviours
Number of anal intercourse with non-steady male partners in the previous 12 months
1	1.00
2–9	0.76 [0.41;1.40]	0.385
10 or more	1.10 [0.71;1.71]	<0.001
Frequency of condom use for anal intercourse with non-steady male partners in the previous 12 months
Never/Seldom/sometimes	1.00
Mostly/always	4.46 [3.62;5.50]	<0.001
Not concerned	2.38 [1.59;3.59]	<0.001
Use of stimulants for sex (“Chemsex”) in the previous 12 months
Yes	1.00
No	1.50[1.22;1.83]	<0.001
Level of outness
Low	1.88 [1.41;2.52]	<0.001
Medium/high	1.00
Self-efficacy (“The sex I have is always as safe as I want it to be”/“I find it easy to say “no” to sex I don’t want”)
Disagree at least once	1.00			1.00
Never disagree	1.55 [1.24;1.92]	<0.001		1.84 [1.29;2.60]	0.001
Hepatitis vaccination history
Vaccinated against hepatitis A
Yes	1.00
No	3.90 [3.12;4;88]	<0.001
I don’t know	9.46[6.36;14.06]	<0.001
Vaccinated against hepatitis B
Yes	1.00			1.00
No	4.03 [3.04;5.33]	<0.001		2.20 [1.45;3.34]	<0.001
I don’t know	6.90[4.43;10.73]	<0.001		1.41 [0.75;2.65]	0.283
HIV testing and HIV prevention knowledge
Last HIV test result within the previous 6 months
Yes	1.00
No	13.65 [8.48;21.97]	<0.001
Prior knowledge on “undetectable = untransmittable” ^(1)
Yes	1.00
No	5.49 [4.15;7.27]	<0.001
Prior knowledge on the possibility of event-based PrEP dosing ^(2)
Yes	1.00			1.00
No	33.62 [23.88;47.35]	<0.001		11.48 [7.37;17.87]	<0.001
Prior knowledge on daily PrEP ^(3)
Yes	1.00			1.00
No	27.72 [16.38;46.89]	<0.001		2.58 [1.27;5.25]	0.009
Access to PrEP
Health professional has spoken personally about PrEP  Yes	1.00
No/don't know	34.12 [25.68;45.33]	<0.001
Spoken personally about PrEP at a hospital or clinic as an out-patient
Yes	1.00			1.00
No	16.99 [13.14;21.98]	<0.001		12.39 [8.90;17.27]	<0.001
Spoken personally about PrEP at a community service or drop-in
Yes	1.00			1.00
No	5.14 [4.02;6.57]	<0.001		4.93 [3.48;6.97]	<0.001
Number of PrEP access points within department of residence
0–1 access point	2.36 [1.78;3.13]	<0.001		1.70 [1.10;2.63]	0.016
2–9 access points	1.37 [1.09;1.71]	0.06		1.18 [0.84;1.65]	0.347
10 or more access points	1.00			1.00

⁽¹⁾ “If someone knows in advance when they will have sex, PrEP needs to be taken as a double dose approximately 24 h before sex and then at both 24 and 48 h after the double dose”.

⁽²⁾ “Pre-Exposure prophylaxis (PrEP) involves someone who does not have HIV taking pills before as well as after sex to prevent them getting HIV”.

⁽³⁾ “PrEP can be taken as a single daily pill if someone does not know in advance when they will have sex”.