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HIV Pre-exposure Prophylaxis (PrEP) Uptake Among Gay and Bisexual Men in Australia and Factors Associated With the Nonuse of PrEP Among Eligible Men

Results From a Prospective Cohort Study

Hammoud, Mohamed A. BPsych (Hons)a; Vaccher, Stefanie BScience (Hons)a; Jin, Fengyi PhDa; Bourne, Adam PhDb; Maher, Lisa PhDa; Holt, Martin PhDc; Bavinton, Benjamin R. PhDa; Haire, Bridget PhDa; Degenhardt, Louisa PhDd; Grulich, Andrew PhDa; Prestage, Garrett P. PhDa

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1, 2019 - Volume 81 - Issue 3 - p e73–e84
doi: 10.1097/QAI.0000000000002047
Prevention Research

Background: HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention strategy, yet some gay and bisexual men (GBM) who are eligible to access PrEP are not using it. We report the incidence of PrEP uptake, factors predicting its initiation, and identify characteristics associated with nonuptake of PrEP among Australian GBM who meet the eligibility criteria.

Methods: The Following Lives Undergoing Change (Flux) Study is a national, online, prospective observational study among GBM focusing on licit and illicit drug use. Participants (N = 1257) responded to baseline and 6-monthly follow-up questionnaires. Incidence per 100 person-years and incidence rate ratios of PrEP initiation are presented. Multivariate Poisson regression was used to examine associations with PrEP initiation and logistic regression to examine associations with nonuptake of PrEP among eligible GBM.

Results: Among GBM who met the eligibility criteria, 69.8% of men did not commence PrEP. Factors independently associated with nonuptake of PrEP were younger age, living in an Australian state without a PrEP trial, lower social engagement with other gay men, less use of illicit party drugs or use of illicit party drugs for sex, and less likely to have engaged in HIV sexual risk behaviors such as group sex or any condomless anal intercourse.

Conclusions: Despite meeting formal eligibility criteria for PrEP, men who were relatively less sexually active or less socially connected were less likely to initiate PrEP. Men who did not initiate PrEP may assess their risk as insufficient relative to others to warrant using PrEP because they engaged in less frequent “risky” behaviors.

aThe Kirby Institute, UNSW Sydney, Sydney, Australia;

bAustralian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia;

cCentre for Social Research in Health, UNSW Sydney, Sydney, Australia; and

dNational Drug and Alcohol Research Centre, UNSW Sydney, Australia.

Correspondence to: Mohamed A. Hammoud, BPsych (Hons), Kirby Institute, UNSW Sydney, Sydney, Australia (e-mail:

The Flux Study is funded by an Australian Research Council Discovery Project. In 2018, the study was partly funded by the Gilead Australia Fellowship: Research Grants Program. The funders of this study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The Kirby Institute, the Centre for Social Research in Health, and National Drug and Alcohol Research Centre are supported by the Australian Government Department of Health. Representatives of the Australian Government Department of Health were not involved in this study. Representatives of these organizations participated in the study reference groups, guiding study design, data collection, and data interpretation and participated in guiding the writing of this article. The lead author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

The authors have no conflicts of interest to disclose.

Received December 15, 2018

Accepted February 20, 2019

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