AIDS and Behavior

, Volume 18, Issue 9, pp 1722–1725 | Cite as

Pre-Exposure Prophylaxis Accessibility Research and Evaluation (PrEPARE Study)

  • Helen L. KingEmail author
  • Samuel B. Keller
  • Michael A. Giancola
  • David A. Rodriguez
  • Jasmine J. Chau
  • Jason A. Young
  • Susan J. Little
  • Davey M. Smith
Original Paper


Tenofovir-emtricitabine (TDF–FTC) has demonstrated effectiveness as HIV preexposure prophylaxis (PrEP), but it is not commonly prescribed. Our study was designed to determine the barriers preventing utilization of PrEP among men who have sex with men (MSM), the group at greatest risk for HIV infection in the United States. A population-based sample of MSM presenting for HIV testing at ‘Early Test’ HIV testing and counseling sites in San Diego, California were offered PrEP and education about potential efficacy. Eligible individuals reported having unprotected sex within the past 12 months and who tested negative for HIV were offered study participation. Despite offering procedures for evaluation and prescription for PrEP to 416 eligible subjects, less than 0.5 % of participants received the drug. Surveys collected from 54 of those who declined study participation revealed multiple barriers to PrEP among MSM including cost, low perceived risk of infection and concerns about taking a daily medication and potential long-term side effects. Efforts should be made to address these barriers, especially lowering the cost of TDF–FTC, education about PrEP side effects and awareness of HIV risks.


Nucleic Acid Amplification Testing Term Side Effect Private Medical Insurance Preexposure Prophylaxis Decline Study Participation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Veterans Affairs and grants from the National Institutes of Health: DA034978, AI69432, AI007384, AI080193, AI096113, AI090970, AI043638, MH62512, MH083552, AI077304, AI36214, AI047745, AI74621, AI080353, AI100665, GM093939; the International AIDS Vaccine Initiative; the James B. Pendleton Charitable Trust.

Supplementary material

10461_2014_845_MOESM1_ESM.doc (368 kb)
Supplementary material 1 (DOC 368 kb)
10461_2014_845_MOESM2_ESM.doc (26 kb)
Supplementary material 2 (DOC 25 kb)


  1. 1.
    Centers for Disease Control and Prevention. HIV in the United States: At a Glance. February 2013. Accessed March, 26 2012.
  2. 2.
    Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine–tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra125.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011 Jan 28;60(3):65–8.Google Scholar
  5. 5.
    Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34 Epub 2012 Jul 11.PubMedCrossRefGoogle Scholar
  7. 7.
    Brooks RA, Landovitz RJ, Kaplan RL, Lieber E, Lee SJ, Barkley TW. Sexual risk behaviors and acceptability of HIV pre-exposure prophylaxis among HIV-negative gay and bisexual men in serodiscordant relationships: a mixed methods study. AIDS Patient Care STDs. 2012;26(2):87–94.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Aghaizu A, Mercey D, Copas A, Johnson AM, Hart G, Nardone A. Who would use PrEP? Factors associated with intention to use among MSM in London: a community survey. Sex Transm Infect. 2013;89(3):207–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Mustanski B, Johnson AK, Garofalo R, Ryan D, Birkett M. Perceived likelihood of using HIV pre-exposure prophylaxis medications among young men who have sex with men. AIDS Behav. 2013;17(6):2173–9.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Krakower D, Mayer KH. Engaging healthcare providers to implement HIV pre-exposure prophylaxis. Curr Opin HIV AIDS. 2012;7(6):593–9.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS. 2013;27(4):248–54. doi: 10.1089/apc.2012.0419.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    County of San Diego Health and Human Services Agency Division of Public Health Services Epidemiology and Immunization Services Branch HIV/AIDS Surveillance Program Epidemiology Report 2012. Accessed 10 December, 2012.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Helen L. King
    • 1
    Email author
  • Samuel B. Keller
    • 1
  • Michael A. Giancola
    • 1
  • David A. Rodriguez
    • 1
  • Jasmine J. Chau
    • 1
  • Jason A. Young
    • 1
  • Susan J. Little
    • 1
  • Davey M. Smith
    • 1
    • 2
  1. 1.University of California San DiegoLa JollaUSA
  2. 2.Veterans Administration San Diego Healthcare SystemSan DiegoUSA

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