Willingness to consider using pre-exposure prophylaxis (PrEP) increased between 2011 and 2017 among gay and bisexual men in Australia, while concerns about using it decreased, according to research published in AIDS and Behavior. Community support for PrEP users remained solid.
“We found that attitudes towards PrEP among Australian GBM [gay and bisexual men] have become more positive over time,” comment the authors. “As willingness to use PrEP has increased in Australia, concern about using it has fallen, although concern was still expressed by over a third of Australian HIV-negative and untested men in 2017. This underscores that PrEP may not be attractive to all GBM, particularly those who are apprehensive about taking medication or side effects.”
Large scale PrEP demonstration projects began in New South Wales and Victoria in 2016. In April 2018 the Australian Pharmaceutical Benefits Advisory Committee recommended that the government should subsidise PrEP and allow any doctor to prescribe it to individuals with a medium or high risk of HIV.
Repeated, national, online, cross-sectional surveys of Australian gay and bisexual men were conducted in 2011, 2013, 2015 and 2017. A total of 4567 gay and bisexual men who were HIV negative or unsure of their HIV status took part in the surveys. Their mean age was 33 years and 99% were born male. The vast majority (94%) identified as gay. Approximately three-quarters lived in a major city, 60% were in full-time employment and 47% had a university degree.
Two-thirds of participants reported having an HIV test in the previous 12 months. Just over half said they’d had condomless anal sex with a primary male partner in the previous six months, with a third reporting recent condomless anal sex with a casual male partner.
As previously reported, use of PrEP has increased significantly over this time. In these surveys, the proportion reporting use of PrEP increased from 3% in 2015 to 26% in 2017. This increase coincided with expanded access to the therapy through research studies and demonstration projects. Almost all (98%) of the individuals using PrEP said they took their medication daily.
Men taking PrEP were more likely than non-users to report condomless anal sex with a casual partner, a high number of sexual partners and a recent sexually transmitted infection. They were more likely than non-users to be in full-time employment and to live in more populous areas.
The proportion of individuals not on PrEP who said they’d be willing to consider taking it increased from 28% in 2011, to 30% in 2015, and to 36% in 2017. The proportion of non-PrEP users reporting concerns about taking PrEP fell from 52% in the 2011 survey, to 41% in 2015, and to 36% in 2017.
A new measure was added to the 2015 asking if non-using men supported gay and bisexual men who were taking PrEP. Just over half (52%) said they were supportive, a proportion that remained unchanged in the 2017 survey.
Likewise, in 2015 participants were asked if they’d be willing to have sex with a man on PrEP, with 35% saying yes. In the 2017 survey, this had increased to 49%.
Approximately three-quarters (74%) of men on PrEP provided answers suggesting they had reduced fear of HIV and more sexual pleasure because of PrEP. In contrast, just 23% of non-users had reduced anxiety of HIV because of other men’s use of PrEP.
The authors analyse their data in relation to Diffusion of Innovations theory. This states that ‘early adopters’ of a new technology tend to be open to change, risk-taking and attracted to new ideas and practices. Those who subsequently use it tend to be less adventurous and risk-taking, deliberating for longer before adopting an innovation. “The next wave of PrEP users in Australia may be less adventurous and require greater reassurance about PrEP’s efficacy and legitimacy,” they say.
Holt M et al. Trends in attitudes to and use of HIV pre-exposure prophylaxis by Australian gay and bisexual men, 2011-2017: implications for further implementation from a diffusion of innovations perspective. AIDS and Behavior, online edition, https://doi.org/10.1007/s10461-018-2368-y (2018).