Acceptability of Oral HIV Pre-Exposure Prophylaxis (PrEP) Among HIV-Negative Men Who Have Sex with Men in Switzerland

Background and Purpose

Worldwide, men who have sex with men (MSM) are overrepresented among those newly diagnosed with HIV-infection. In Switzerland, the epidemic has remained relatively stable during the past years. Despite a wide range of interventions in place almost half of the new diagnoses are in MSM. So, providing adequate HIV-prevention offers for MSM remains a continuing challenge for health professionals and social workers. Although oral HIV Pre-exposure Prophylaxis (PrEP) has not been approved in Switzerland, it is discussed as an additional prevention method for MSM. In the USA, PrEP was approved in 2012. However, there is evidence from the USA that MSM are not as keen to use PrEP as expected. Regarding MSM living in Switzerland a qualitative elicitation study has showed that participants had concerns about negative side effects and costs. Therefore, this study tried to determine the acceptability of PrEP among HIV-negative MSM living in Switzerland.

 Methods

In a cross-sectional study, we surveyed a convenience sample of 556 MSM by using an anonymous, standardized self-administered online-questionnaire. Participants were recruited through flyers distributed in bars and gay health clinics, advertisements in gay magazines and posts on various gay-specific web pages and Facebook. We operationalized the acceptability of PrEP as the intention to use this new prevention option. It was measured by one item about the intention to use PrEP according to the guidelines adopted by the US Centers for Disease Control and Prevention. Answers ranged from 1="extremely unlikely" to 7="extremely likely". We carried out descriptive and inferential statistics. 

Results

Eighty-eight percent were gay and 11% bisexual men. Mean age was 40.6 years (SD=11.9). During the past six months, 48% have had a sexual encounter with at least one casual partner and 16% have been treated for an sexually transmitted infection (STI). Almost 73% were already aware of PrEP before the survey, but only 18% rated their knowledge as good to very good. The mean score of intention to use PrEP was 3.7 (SD=2.1). Thirty-nine percent reported to be likely (ranging from likely to extremely likely) to use PrEP if available. However, almost 51% were not likely to usePrEP when available. Only 10% were undecided about using PrEP. The acceptability of PrEP was higher among MSM having had sex with casual partners (M=3.8, SD=2.1) and having been treated for an STI (M=4.3, SD=2.0) than in MSM with no casual partners (M=3.0, SD=1.9, t=3.64, p<.001) or STI (M=3.6, SD=2.1, t=2.98, p<.01) during the past six months. Also MSM who were previously aware of PrEP had higher acceptability scores (M=3.8, SD=2.2) than MSM who have never heard about PrEP before (M=3.3, SD=2.0, t=2.22, p<.05).

 Conclusions and Implications

Results showed moderate acceptability of oral PrEP among the participants. Although, MSM with casual sex partners and previous knowledge of PrEP showed higher intention to use PrEP, the acceptability remains moderate. It seems that participants are reluctant to make use of this chemo-prophylaxis. Further research is needed, in order to elicit and model the factors influencing MSM’s intention to use PrEP.