Pre-exposure prophylaxis use among MSM in the SF Bay Area

Albert Liu, Public Health Foundation Enterprises, Inc.
Social and Behavioral

Background: Pre-exposure prophylaxis (also known as PrEP) is the use of anti-HIV medicines by an HIV-negative person in an attempt to prevent HIV infection. Currently it is not known whether PrEP is safe or effective in HIV-negative individuals, and several large studies are evaluating these questions around the world. Meanwhile, there is preliminary evidence that men who have sex with men (MSM) in California are beginning to use PrEP in an unapproved fashion. This illicit use of PrEP could be harmful both to the individual and the community. This study will determine how frequently HIV-negative MSM in the San Francisco Bay Area are using PrEP, and determine factors associated with use. We will also determine how and in what context these men are using PrEP. Finally, through survey data and in-depth interviews with men who use PrEP, we will develop an innovative intervention for MSM PrEP users to help them reduce their risk for HIV infection as well as other possible harms from PrEP use.

Study plan: This study will begin with focus groups of MSM and interviews with key informants to refine interview questions for our community based survey and our in-depth interviews. We will next gather data over a 4 month period at various locations where MSM frequent in the San Francisco Bay Area using a face-to-face survey of 400 HIV-negative MSM. Those men who report using PrEP will be recruited for in-depth interviews held at the San Francisco Department of Public Health. During in-depth interviews, we will ask participants for more information regarding their patterns and context of PrEP use, as well as questions regarding the types of interventions that would be most helpful for MSM using PrEP. We will also provide a brief educational session on PrEP and offer free HIV testing and risk-reduction counseling.

Implications: Data from this survey will provide the first reliable estimate of how common PrEP use is among HIV-negative MSM in the San Francisco Bay Area. It will also provide more information about the characteristics of MSM who are using PrEP. This study will also be the first to develop a new pilot intervention for MSM who report PrEP use. Data from this pilot study will complement current clinical trials of PrEP around the world and will be critical in minimizing harm to individuals and communities. This information will also be instrumental in planning next steps for future PrEP studies and possible implementation in California.