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Anti-retroviral Therapy Based HIV Prevention Among a Sample of Men Who Have Sex with Men in Cape Town, South Africa: Use of Post-exposure Prophylaxis and Knowledge on Pre-exposure Prophylaxis

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Abstract

Men who have Sex with Men (MSM) have been affected disproportionately by the global HIV pandemic. Rates of consistent condom-use are low and there is a need for further biomedical prevention interventions to prevent new HIV infections. Post exposure prophylaxis (PEP) can reduce the risk of HIV, but uptake among MSM is low. Pre-exposure prophylaxis (PrEP), an innovative anti-retroviral-based HIV prevention tool might be an appropriate intervention for MSM who have recently accessed PEP that involves HIV negative individuals taking daily tenofovir+emtricitabine for HIV prevention. 44 MSM, attending a primary health-care level MSM-focused sexual health clinic in Cape Town, South Africa, who had initiated PEP were enrolled in this study. Participants were followed up after 2, 4 and 12 weeks. Self-administered electronic surveys were completed at the initial, 4 and 12 week visit. Barriers and facilitators to accessing PEP and remaining adherent were examined, as was knowledge about PrEP. Thirty-two participants (80 %) were <40 years of age (range 20–65 years). 35 % of the participants reported their reason for requiring PEP as condomless receptive anal intercourse. A further 20 % required PEP following condomless penetrative anal intercourse; 27.5 % required PEP due to a broken condom during receptive anal sex and 2 participants during insertive anal sex. Three participants did not complete 28 days of PEP or were lost to follow up. Over half (58.5 %) of the participants reported being completely adherent to their regime; under a third (31.7 %) reported missing one PEP dose; and 9.8 % reported missing more than one dose. 36/40 (90 %) had heard of PrEP and 30/40 (75 %) indicated that they would use PrEP if it were accessible to them. That we enrolled 44 MSM who accessed PEP from a Department of Health affiliated clinic over 12 months, speaks to the low uptake by MSM of PEP services in South Africa. Adherence was high and demonstrates that adherence support is feasible from a state health clinic. Reported risk behaviors in some high-risk participants did not change over time, demonstrating the need for additional longer-term HIV preventions such as PrEP. PEP users could conceivably be transitioned from PEP to PrEP.

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Acknowledgments

We would like to thank the men who participated in the study, the University of Pittsburgh, Graduate School of Public Health and Anova Health Institute’s Health4Men program for making this work possible. Our thanks to Mr. Glenn de Swardt who was instrumental in developing the idea to explore Post Exposure Prophylaxis and Mr. Grant Cairns who assisted with protocol implementation.

Funding

This research was supported by amfAR, The Foundation for AIDS Research, Grant #108471. A training program for research among MSM in developing world settings and #108801, HIV Research among MSM in Developing World Settings (South Africa).

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Authors and Affiliations

  1. Anova Health Institute, Health4Men Programme, Johannesburg and Cape Town, South Africa

    J. M. Hugo, K. Rebe, G. De Swardt, H. Struthers & J. A. McIntyre

  2. Behavioral and Community Health Sciences, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA

    R. D. Stall & J. E. Egan

  3. Center for LGBT Health Research, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA

    R. D. Stall & J. E. Egan

  4. Department of Internal Medicine, University of Cape Town, Cape Town, South Africa

    K. Rebe

  5. Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa

    H. Struthers

  6. School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa

    J. A. McIntyre

Authors
  1. J. M. Hugo
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  2. R. D. Stall
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  3. K. Rebe
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  4. J. E. Egan
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  5. G. De Swardt
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  6. H. Struthers
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  7. J. A. McIntyre
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Corresponding author

Correspondence to J. M. Hugo.

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Conflict of Interest

All authors have no conflicts of interest.

Ethical Approval

The Institutional Review Board (IRB) at the University of Pittsburgh (PRO13050334) and The Human Research Ethics Committee (HREC) of the University of Cape Town, South Africa (HREC REF: 566/2013) approved study procedures. All procedures were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The men were reimbursed in this study.

Informed Consent

Informed Consent was obtained from all individual participants included in the study.

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Hugo, J.M., Stall, R.D., Rebe, K. et al. Anti-retroviral Therapy Based HIV Prevention Among a Sample of Men Who Have Sex with Men in Cape Town, South Africa: Use of Post-exposure Prophylaxis and Knowledge on Pre-exposure Prophylaxis. AIDS Behav 20 (Suppl 3), 357–364 (2016). https://doi.org/10.1007/s10461-016-1536-1

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  • DOI: https://doi.org/10.1007/s10461-016-1536-1

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