Sexual risk taking under informal PrEP users

Abstract

Background: PrEP (Pre-Exposure Prophylaxis) is a biomedical intervention to reduce HIV infections. Although the efficacy of PrEP has been demonstrated in several trials, PrEP is only available in a few countries. As a consequence, men who have sex with men (MSM) try to get PrEP via informal ways, for example via tourism to countries where PrEP is available and affordable. We explore whether informal PrEP users use PrEP correctly and if they involve in sexual risk taking behavior. Methods: MSM clients of the Silom Pulse Clinic in Bangkok, and visitors of a Dutch PrEP interest website, completed a survey about PrEP use, sexual health and behavior. Data collection is ongoing. Our preliminary results are based on the analysis of the 100 respondents who completed the survey in the first weeks. Results: 65 respondents (65%) were using PrEP informally. PrEP users showed high risk sexual behavior, such as a high amount of sexual partners in the past 6 months (M=19.9, SD=22.0) and visited circuit parties (26 participants, 40.0%) and sex parties (24 participants, 36.9%). A daily regimen (48 participants, 73.8%) prevailed, 16 participants (24.6%) used PrEP intermittently. Especially in this last group PrEP use seems “suboptimalâ€, such as low adherence and lack of checkups. Discussion: While PrEP is an effective HIV prevention when used correctly, current availability forces users to engage in so-called PrEP tourism. The resulting lack of counseling and medical checks, as well as intermittent use, create a higher likelihood of suboptimal regimens and thus overestimated HIV protection levels.