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Limited Knowledge and Use of HIV Post- and Pre-Exposure Prophylaxis Among Gay and Bisexual Men

Liu, Albert Y MD, MPH*†; Kittredge, Pravina V PhD, MPH*; Vittinghoff, Eric PhD; Raymond, H Fisher MPH*; Ahrens, Katherine MPH*; Matheson, Tim PhD*; Hecht, Jennifer MPH; Klausner, Jeffrey D MD, MPH*†; Buchbinder, Susan P MD*†

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2008 - Volume 47 - Issue 2 - p 241-247
doi: 10.1097/QAI.0b013e31815e4041
Epidemiology and Social Science

Background: Post-exposure prophylaxis (PEP) is currently recommended after certain high-risk exposures, and pre-exposure prophylaxis (PrEP) is undergoing evaluation in clinical trials. Media reports have suggested substantial levels of community PrEP use despite its unproven effectiveness.

Methods: We conducted a cross-sectional survey of 1819 HIV-uninfected gay/bisexual men in California to assess PEP and PrEP awareness and use.

Results: Overall, 47% reported PEP awareness and 4% ever used PEP. Men who were older than 25 years of age (odds ratio [OR] = 2.2, 95% confidence interval [CI]: 1.5 to 3.1), were white (OR = 2.2, 95% CI: 1.6 to 3.0), had an annual income >$100,000 (OR = 2.0, 95% CI: 1.2 to 3.4), self-identified as gay/homosexual (OR = 2.4, 95% CI: 1.4 to 4.3), and had unprotected anal sex (OR = 1.8, 95% CI: 1.3 to 2.3) or sex under the influence of a drug (OR = 2.0, 95% CI: 1.5 to 2.7) were more likely to be aware of PEP, whereas speed users (OR = 0.6, 95% CI: 0.4 to 0.9) were less likely to be aware of PEP. Only 16% reported PrEP awareness, and <1% ever used PrEP. Unprotected anal sex (OR = 1.6, 95% CI: 1.1 to 2.3) and sex under the influence of a drug (OR = 1.5, 95% CI: 1.0 to 2.2) were associated with PrEP awareness.

Conclusions: PEP awareness and use were modest and PrEP use was rare among gay/bisexual men in California. Although PrEP is not currently recommended, community education on the availability of PEP is suggested.

From the *Department of Medicine, San Francisco Department of Public Health, San Francisco, CA; †Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; and ‡STOP AIDS Project, San Francisco, CA.

Received for publication June 21, 2007; accepted October 12, 2007.

Supported by funds from the Universitywide AIDS Research Program, grant ID05-PHFE-018. An earlier analysis of these data was presented at the XVI International AIDS Conference, Toronto, Ontario, Canada, August 13-18, 2006, and at the First International Workshop on HIV Transmission-Principles of Intervention, Toronto, Ontario, Canada, August 11-12, 2006.

Correspondence to: Albert Liu, MD, MPH, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102-6033 (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.