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 non-uptake of PrEP among Australian GBM who meet the eligibility criteria.
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 six-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 non-uptake of PrEP among eligible GBM.
Among GBM who met the eligibility criteria, 69.8% of men did not commence PrEP. Factors independently associated with non-uptake 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 illicit party drugs for sex, and less likely to engaged in HIV sexual risk behaviours such as group sex or any condomless anal intercourse.
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’ behaviours.
1The Kirby Institute, UNSW Sydney, Australia
2Australian Research Centre in Sex Health and Society, La Trobe University, Australia
3Centre for Social Research in Health, UNSW Sydney, Australia
4National Drug and Alcohol Research Centre, UNSW Sydney, Australia
Corresponding Author: Mohamed Ahmed Hammoud, BPsych(Hons) The Kirby Institute, UNSW Australia Sydney, New South Wales AUSTRALIA
Declaration of interest: 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.