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Trends in Attitudes to and the Use of HIV Pre-exposure Prophylaxis by Australian Gay and Bisexual Men, 2011–2017: Implications for Further Implementation from a Diffusion of Innovations Perspective

  • Martin HoltEmail author
  • Toby Lea
  • Brandon Bear
  • Dale Halliday
  • Jeanne Ellard
  • Dean Murphy
  • Johann Kolstee
  • John de Wit
Original Paper

Abstract

Using repeated, national, online, cross-sectional surveys of Australian gay and bisexual men (GBM), we analysed trends related to HIV pre-exposure prophylaxis (PrEP). Specifically, we analysed trends in PrEP use, willingness to use PrEP, and concern about using PrEP during 2011–2017. We assessed support for GBM using PrEP and willingness to have sex with men taking PrEP between 2015 and 2017. For time-based analyses, we used multivariate logistic regression, controlling for sampling variations over time. We constructed new scales assessing reduced concern about HIV among PrEP users and non-users in 2017, and used multivariate logistic regression to identify independent correlates of PrEP use (vs. non-use). The analyses included 4567 HIV-negative and untested participants (2011–2017). PrEP use increased from 0.5% in 2011 to 25.5% in 2017 (p < 0.001). Willingness to use PrEP increased from 27.9% in 2011 to 36.5% in 2017 (p < 0.001) while concern about using PrEP fell (52.1–36.1%, p < 0.001). Support for GBM using PrEP remained stable (52.5% in 2015, 51.9% in 2017, p = 0.62), and willingness to have sex with men taking PrEP increased from 34.9% in 2015 to 49.0% in 2017 (p < 0.001). In 2017, 22.8% of non-PrEP-users had reduced HIV concern because of PrEP, while 73.6% of PrEP users had reduced HIV concern and greater sexual pleasure because of PrEP. The analysis of PrEP users vs. non-users in 2017 indicated that PrEP users were more sexually active and reported higher risk sexual practices, were more likely to live in New South Wales and Victoria, and to be in full-time employment. They were also more likely to know HIV-positive people and other PrEP users. Diffusion of Innovations theory suggests that future PrEP users in Australia may be less adventurous and require greater reassurance about PrEP’s efficacy and legitimacy, to sustain rollout and address current disparities in uptake.

Keywords

HIV prevention Pre-exposure prophylaxis Attitudes Behaviour Acceptability research Australia 

RESUMEN

Utilizando encuestas repetidas, nacionales, en línea y transversales de hombres gay y bisexuales australianos, analizamos las tendencias relacionadas con la profilaxis de pre exposición al VIH (PrEP). Específicamente, analizamos las tendencias en el uso de PrEP, la disposición para usar PrEP y la preocupación sobre el uso de PrEP durante 2011–2017. Evaluamos el apoyo para hombres gay y bisexuales que usan PrEP y la disposición de tener relaciones sexuales con hombres que usan PrEP entre 2015 y 2017. Para los análisis basados en el tiempo, utilizamos la regresión logística multi-variable, controlando las variaciones de muestreo a lo largo del tiempo. Construimos nuevas escalas evaluando la preocupación reducida sobre el VIH entre los usuarios y no usuarios de PrEP en 2017, y utilizamos la regresión logística multi-variable para identificar los correlatos independientes del uso de PrEP (versus el no uso). Los análisis incluyeron 4567 participantes VIH-negativos y no probados (2011–2017). El uso de PrEP aumentó del 0.5% en 2011 al 25.5% en 2017 (p < 0.001). La disposición para usar PrEP aumentó del 27.9% en 2011 al 36.5% en 2017 (p < 0.001), mientras que la preocupación de usar PrEP disminuyó (52.1-36.1%, p < 0.001). Apoyo para los hombres gay o bisexuales usando PrEP se mantuvo estable (52.5% en 2015, 51.9% en 2017, p = 0.62), y la disposición de tener relaciones sexuales con hombres usando PrEP aumentó del 34.9% en 2015 al 49.0% en 2017 (p < 0.001). En 2017, el 22.8% de participantes que no usan PrEP redujeron su preocupación del VIH debido a PrEP, mientras que el 73.6% de los participantes que toman PrEP redujeron su preocupación del VIH y reportaron mayor placer sexual debido a PrEP. El análisis de participantes que usan PrEP versus los que no lo usan en 2017 indicó que los usuarios de PrEP eran más activos sexualmente y reportaron prácticas sexuales de mayor riesgo, era más probable que vivían en los estados de Nueva Gales del Sur y Victoria, y que tenían empleo de tiempo completo. También era más probable que conocían a personas VIH positivas y otros usuarios de PrEP. La teoría de la difusión de innovaciones sugiere que los futuros usuarios de PrEP en Australia podrán ser menos aventureros y requerirán más seguridad sobre la eficacia y legitimidad de PrEP, para sostener su implementación y abordar las disparidades actuales en su consumo.

Notes

Acknowledgements

We acknowledge all the gay and bisexual men who participated in the research and the other members of the PrEPARE Project reference group (David Crawford and Heather-Marie Schmidt). The PrEPARE Project was supported by funding from the Bloodborne Virus Research Intervention and Strategic Evaluation program of the New South Wales Ministry of Health and surveillance funding from the Australian Government Department of Health.

Author Contributions

All authors contributed to the study design, analysis and interpretation of findings. TL conducted the statistical analyses with input from MH. MH wrote the majority the manuscript, with support from TL. All authors read and contributed to drafts of the article prior to submission.

Compliance with Ethical Standards

Conflict of Interest

The authors have no conflicts of interest to declare.

Ethics Approval

This study was carried out in accordance with the National Statement on Ethical Conduct in Human Research, from the National Health and Medical Research Council, Australia. All participants indicated informed consent at the start of the online questionnaire. The study design was approved by the Human Research Ethics Committee of the University of New South Wales and the Research Ethics Review Committee of the community organisation ACON.

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Copyright information

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

Authors and Affiliations

  1. 1.Centre for Social Research in HealthUNSW SydneySydneyAustralia
  2. 2.German Institute for Addiction and Prevention ResearchCatholic University of Applied SciencesCologneGermany
  3. 3.ACONSydneyAustralia
  4. 4.New South Wales Ministry of HealthSydneyAustralia
  5. 5.Australian Federation of AIDS OrganisationsSydneyAustralia
  6. 6.Department of Gender and Cultural StudiesUniversity of SydneySydneyAustralia
  7. 7.The Kirby InstituteUNSW SydneySydneyAustralia
  8. 8.Department of Interdisciplinary Social ScienceUtrecht UniversityUtrechtThe Netherlands
  9. 9.Centre for Social Research in HealthUNSW SydneySydneyAustralia

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