AIDS and Behavior

, Volume 23, Issue 7, pp 1771–1779 | Cite as

Perceived Candidacy for Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men in Paris, France

  • Samuel DubinEmail author
  • William C. Goedel
  • Su Hyun Park
  • H. Rhodes Hambrick
  • John A. Schneider
  • Dustin T. Duncan
Original Paper


Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34–2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07–1.50, aRR 1.32; 95% CI 1.13–1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21–4.16, aRRR 2.58; 95% CI 1.09–6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03–0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions.


Pre-exposure prophylaxis Candidacy HIV prevention Men who have sex with men Geosocial-networking smartphone application 



We thank the translators and participants of this study who contributed to the project.


Dr. Dustin Duncan was funded in part by National Institutes of Health Grants R01MH112406, R21MH110190, and R03DA039748 and the Centers for Disease Control and Prevention Grant U01PS005122.

Compliance with Ethical Standards

Conflict of interest

All authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

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


  1. 1.
    World Health Organization. World health statistics. Geneva: World Health Organization; 2016.Google Scholar
  2. 2.
    Poder A, Haldre M. HIV in Europe. Clin Dermatol. 2014;32(2):282–5.CrossRefGoogle Scholar
  3. 3.
    European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2015. Stockholm: ECDC; 2016.Google Scholar
  4. 4.
    European Centre for Disease Prevention and Control. HIV and men who have sex with men. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017.Google Scholar
  5. 5.
    Molina J-M. PrEP Roll-Out in France. World AIDS Conference; 2016; Durban, South Africa.Google Scholar
  6. 6.
    Le Vu S, Velter A, Meyer L, et al. Biomarker-based HIV incidence in a community sample of men who have sex with men in Paris, France. PLoS ONE. 2012;7(6):e39872.CrossRefGoogle Scholar
  7. 7.
    Marcus U, Hickson F, Weatherburn P, Schmidt AJ. Estimating the size of the MSM populations for 38 European countries by calculating the survey-surveillance discrepancies (SSD) between self-reported new HIV diagnoses from the European MSM internet survey (EMIS) and surveillance-reported HIV diagnoses among MSM in 2009. BMC public health. 2013;13:919.CrossRefGoogle Scholar
  8. 8.
    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.CrossRefGoogle Scholar
  9. 9.
    McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet (London, England). 2016;387(10013):53–60.CrossRefGoogle Scholar
  10. 10.
    Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373(23):2237–46.CrossRefGoogle Scholar
  11. 11.
    Volk JE, Marcus JL, Phengrasamy T, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting. Clin Infect Dis. 2015;61(10):1601–3.CrossRefGoogle Scholar
  12. 12.
    Molina J-M. PrEP Roll-Out in France. Paper presented at: World AIDS Conference2016; Durban, South Africa.Google Scholar
  13. 13.
    Kirby T, Thornber-Dunwell M. Uptake of PrEP for HIV slow among MSM. Lancet. 2014;383(9915):399–400.CrossRefGoogle Scholar
  14. 14.
    Nunn AS, Brinkley-Rubinstein L, Oldenburg CE, et al. Defining the HIV pre-exposure prophylaxis care continuum. AIDS. 2017;31(5):731–4.CrossRefGoogle Scholar
  15. 15.
    Liu A, Cohen S, Follansbee S, et al. Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco. PLoS Med. 2014;11(3):1613.CrossRefGoogle Scholar
  16. 16.
    Wilton J, Kain T, Fowler S, et al. Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk. J Int AIDS Soc. 2016;19(1):20777.CrossRefGoogle Scholar
  17. 17.
    Parsons JT, Rendina HJ, Lassiter JM, Whitfield TH, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a National cohort of gay and bisexual men in the United States. J Acquir Immune Def Synd. 2017;74(3):285–92.CrossRefGoogle Scholar
  18. 18.
    Brooks RA, Landovitz RJ, Regan R, Lee SJ, Allen VC Jr. Perceptions of and intentions to adopt HIV pre-exposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS. 2015;26(14):1040–8.CrossRefGoogle Scholar
  19. 19.
    Dolezal C, Frasca T, Giguere R, et al. Awareness of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) is low but interest is high among men engaging in condomless anal sex with men in Boston, Pittsburgh, and San Juan. AIDS Edu Prev. 2015;27(4):289–97.CrossRefGoogle Scholar
  20. 20.
    Krakower DS, Mimiaga MJ, Rosenberger JG, et al. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. PLoS ONE. 2012;7(3):e33119.CrossRefGoogle Scholar
  21. 21.
    Ferrer L, Folch C, Fernandez-Davila P, et al. Awareness of pre-exposure prophylaxis for HIV, willingness to use it and potential barriers or facilitators to uptake among men who have sex with men in Spain. AIDS Behav. 2016;20(7):1423–33.CrossRefGoogle Scholar
  22. 22.
    Frankis JS, Young I, Lorimer K, Davis M, Flowers P. Towards preparedness for PrEP: PrEP awareness and acceptability among MSM at high risk of HIV transmission who use sociosexual media in four Celtic nations: Scotland, Wales, Northern Ireland and The Republic of Ireland: an online survey. Sex Transmit Infect. 2016;92(4):279–85.CrossRefGoogle Scholar
  23. 23.
    Eaton LA, Matthews DD, Driffin DD, Bukowski L, Wilson PA, Stall RD. A multi-US City assessment of awareness and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among black men and transgender women who have sex with men. Prev Sci. 2017;18(5):505–16.CrossRefGoogle Scholar
  24. 24.
    Strauss BB, Greene GJ, Phillips G 2nd, et al. Exploring patterns of awareness and use of HIV pre-exposure prophylaxis among young men who have sex with men. AIDS Behav. 2017;21(5):1288–98.CrossRefGoogle Scholar
  25. 25.
    Barash EA, Golden M. Awareness and use of HIV pre-exposure prophylaxis among attendees of a seattle gay pride event and sexually transmitted disease clinic. AIDS Pat Care STDs. 2010;24(11):689–91.CrossRefGoogle Scholar
  26. 26.
    Bauermeister JA, Meanley S, Pingel E, Soler JH, Harper GW. PrEP awareness and perceived barriers among single young men who have sex with men. Curr HIV Res. 2013;11(7):520–7.CrossRefGoogle Scholar
  27. 27.
    Gallagher T, Link L, Ramos M, Bottger E, Aberg J, Daskalakis D. Self-perception of HIV risk and candidacy for pre-exposure prophylaxis among men who have sex with men testing for HIV at commercial sex venues in New York City. LGBT Health. 2014;1(3):218–24.CrossRefGoogle Scholar
  28. 28.
    Bil JP, Davidovich U, van der Veldt WM, et al. What do Dutch MSM think of preexposure prophylaxis to prevent HIV-infection? A cross-sectional study. AIDS. 2015;29(8):955–64.CrossRefGoogle Scholar
  29. 29.
    Cohen SE, Vittinghoff E, Bacon O, et al. High interest in preexposure prophylaxis among men who have sex with men at risk for HIV infection: baseline data from the US PrEP demonstration project. J Acquir Immune Def Synd. 2015;68(4):439–48.CrossRefGoogle Scholar
  30. 30.
    Frankis J, Young I, Flowers P, McDaid L. Who will use pre-exposure prophylaxis (PrEP) and why?: understanding PrEP awareness and acceptability amongst men who have sex with men in the UK—a mixed methods study. PLoS ONE. 2016;11(4):e0151385.CrossRefGoogle Scholar
  31. 31.
    Rojas Castro D, Quatremere G, Sagaon-Teyssier L, et al. Informal pre-exposure prophylaxis use in France: results from the Flash PrEP survey (2014). HIV Med. 2017;18(4):308–10.CrossRefGoogle Scholar
  32. 32.
    Grant RM, Anderson PL, McMahan V, et al. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis. 2014;14(9):820–9.CrossRefGoogle Scholar
  33. 33.
    Khanna AS, Michaels S, Skaathun B, et al. Preexposure prophylaxis awareness and use in a population-based sample of young black men who have sex with men. JAMA Int Med. 2016;176(1):136–8.CrossRefGoogle Scholar
  34. 34.
    Lorente N, Fugon L, Carrieri MP, et al. Acceptability of an “on-demand” pre-exposure HIV prophylaxis trial among men who have sex with men living in France. AIDS Care. 2012;24(4):468–77.CrossRefGoogle Scholar
  35. 35.
    Mehta SA, Silvera R, Bernstein K, Holzman RS, Aberg JA, Daskalakis DC. Awareness of post-exposure HIV prophylaxis in high-risk men who have sex with men in New York City. Sex Transmit Infect. 2011;87(4):344–8.CrossRefGoogle Scholar
  36. 36.
    Young I, Li J, McDaid L. Awareness and willingness to use HIV pre-exposure prophylaxis amongst gay and bisexual men in Scotland: implications for biomedical HIV prevention. PLoS ONE. 2013;8(5):e64038.CrossRefGoogle Scholar
  37. 37.
    Hambrick HR, Park SH, Goedel WC, et al. Rectal douching among men who have sex with men in paris: implications for HIV/STI risk behaviors and rectal microbicide development. AIDS Behav. 2017;22:379–87.CrossRefGoogle Scholar
  38. 38.
    Duncan DT, Park SH, Goedel WC, et al. Perceived neighborhood safety is associated with poor sleep health among gay, bisexual, and other men who have sex with men in Paris, France. J Urban Health. 2017;94(3):399–407.CrossRefGoogle Scholar
  39. 39.
    Hirshfield S, Schrimshaw EW, Stall RD, Margolis AD, Downing MJ Jr, Chiasson MA. Drug use, sexual risk, and syndemic production among men who have sex with men who engage in group sexual encounters. Am J Public Health. 2015;105(9):1849–58.CrossRefGoogle Scholar
  40. 40.
    Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.CrossRefGoogle Scholar
  41. 41.
    Goedel WC, Schneider JA, Hambrick HR, et al. Are anal sex roles associated with preferences for pre-exposure prophylaxis administration modalities among men who have sex with men? Arch Sex Behav. 2017. Scholar
  42. 42.
    Gama A, Abecasis A, Pingarilho M, et al. Cruising venues as a context for HIV risky behavior among men who have sex with men. Arch Sex Behav. 2017;46(4):1061–8.CrossRefGoogle Scholar
  43. 43.
    Liu A, Colfax G, Cohen S, Bacon O. The spectrum of engagement in HIV prevention: Proposal for a Pre-Exposure Prophylaxis (PrEP) cascade. 7th International Conference on HIV Treatment and Prevention Adherence. 2012.Google Scholar
  44. 44.
    Kellerman SE, Lehman JS, Lansky A, et al. HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing. J Acquir Immune Def Synd. 2002;31(2):202–10.CrossRefGoogle Scholar
  45. 45.
    Brisson J, Nguyen VK. Science, technology, power and sex: PrEP and HIV-positive gay men in Paris. Cult Health Sex. 2017;19:1–12.CrossRefGoogle Scholar
  46. 46.
    Goedel WC, Halkitis PN, Greene RE, Duncan DT. Correlates of awareness of and willingness to use pre-exposure prophylaxis (PrEP) in gay, bisexual, and other men who have sex with men who use geosocial-networking smartphone applications in New York City. AIDS Behav. 2016;20(7):1435–42.CrossRefGoogle Scholar
  47. 47.
    King HL, Keller SB, Giancola MA, et al. Pre-exposure prophylaxis accessibility research and evaluation (PrEPARE Study). AIDS Behav. 2014;18(9):1722–5.CrossRefGoogle Scholar
  48. 48.
    Zou H, Fan S. Characteristics of men who have sex with men who use smartphone geosocial networking applications and implications for HIV Interventions: a systematic review and meta-analysis. Arch Sex Behav. 2017;46(4):885–94.CrossRefGoogle Scholar
  49. 49.
    Lehmiller JJ, Ioerger M. Social networking smartphone applications and sexual health outcomes among men who have sex with men. PLoS ONE. 2014;9(1):e86603.CrossRefGoogle Scholar
  50. 50.
    Chayes MNYC. NYC promotes acceptance of controversial HIV drug. New York: Newsday; 2014.Google Scholar
  51. 51.
    Holloway IW, Rice E, Gibbs J, Winetrobe H, Dunlap S, Rhoades H. Acceptability of smartphone application-based HIV prevention among young men who have sex with men. AIDS Behav. 2014;18(2):285–96.CrossRefGoogle Scholar
  52. 52.
    Goedel WC, Halkitis PN, Greene RE, Hickson DA, Duncan DT. HIV risk behaviors, perceptions, and testing and preexposure prophylaxis (PrEP) awareness/use in grindr-using men who have sex with men in Atlanta, Georgia. J Assoc Nurses AIDS Care. 2016;27(2):133–42.CrossRefGoogle Scholar
  53. 53.
    Centers for Disease Control and Prevention. Preexposure prophylaxis for the prevention of HIV infection in the United States: a clinical practice guideline. Atlanta: CDC; 2014.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Samuel Dubin
    • 1
    • 4
    Email author
  • William C. Goedel
    • 1
  • Su Hyun Park
    • 1
  • H. Rhodes Hambrick
    • 1
  • John A. Schneider
    • 2
    • 3
  • Dustin T. Duncan
    • 1
  1. 1.Spatial Epidemiology Lab, Department of Population HealthNew York University School of MedicineNew YorkUSA
  2. 2.Departments of Medicine and Public Health SciencesUniversity of ChicagoChicagoUSA
  3. 3.Chicago Center for HIV EliminationUniversity of ChicagoChicagoUSA
  4. 4.Spatial Epidemiology Lab, Department of Population HealthNew York University School of MedicineNew YorkUSA

Personalised recommendations