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      Awareness, knowledge, use, willingness to use and need of Pre-Exposure Prophylaxis (PrEP) during World Gay Pride 2017

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          Abstract

          Objective

          To assess the awareness, knowledge, use, and willingness to use and need of PrEP among men who have sex with men (MSM) and transgender women (TW) who attended World Gay Pride (WGP) 2017 in Madrid.

          Design and methods

          Online survey. Participants were recruited through gay-oriented dating apps and HIV Non-Governmental Organizations´ social media. Inclusion criteria included being MSM or TW, age 18 years old or above, and having attended WGP in Madrid. Information regarding the participant’s awareness and knowledge, use or willingness to use, and need for PrEP was collected, as well as sociodemographic characteristics. Participants were considered to be in need of PrEP if they met one of the following indication criteria: having practiced unprotected anal intercourse with more than 2 partners, having practiced chemsex, or having engaged in commercial sex—all in the preceding 6 months. Descriptive and multivariable analyses with logistic regression were conducted.

          Results

          472 participants met the inclusion criteria and completed the questionnaire. The mean age was 38, 97.7% were MSM, 77% had a university education, and 85% were living in Spain, mostly in big cities. Overall, 64% of participants were aware of PrEP, but only 33% knew correctly what PrEP was. 67% of HIV-negative participants were willing to take PrEP, although only 5% were taking it during WGP, mostly due to lack of access. 43% of HIV-negative respondents met at least one PrEP indication criteria. For HIV-negative men living in Spain, university education and living in big cities was associated with PrEP awareness. Lower education level and meeting PrEP criteria was associated with willingness to use PrEP.

          Conclusions

          Our study shows that among MSM attending WGP 2017 in Madrid, there was limited PrEP awareness, low accuracy of PrEP knowledge, and a high need and willingness to use PrEP. Health authorities should strengthen existing preventive strategies and implement PrEP.

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          Most cited references14

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          How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize "Truvada Whores".

          Antiretroviral preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate [Truvada]) prevents HIV without penalizing sexual pleasure, and may even enhance pleasure (e.g., by reducing HIV-related anxiety). However, concern about sexual risk behavior increasing with PrEP use (risk compensation) and corresponding stereotypes of promiscuity may undermine PrEP's preventive potential. In this commentary, we review literature on sexual behavior change accompanying PrEP use, discuss risk compensation concerns and the "Truvada whore" stereotype as PrEP barriers, question the appropriateness of restricting PrEP access because of risk compensation, and consider sexual pleasure as a benefit of PrEP, an acceptable motive for seeking PrEP, and a core element of health. It is essential for science to trump stereotypes and sex-negative messaging in guiding decision-making affecting PrEP access and uptake.
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            Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation

            Background In the UK, HIV incidence among men having sex with men (MSM) remains high despite the widespread use of antiretroviral therapy and high rates of virological suppression. Pre-Exposure Prophylaxis (PrEP) has been shown to be highly effective in preventing further infections in MSM, but its cost-effectiveness is less certain. Methods A dynamic, individual-based stochastic model, the Synthesis model, was calibrated to multiple data sources on HIV among UK MSM. We evaluated the introduction of a PrEP programme with sexual event-based use of Emtricitabine/Tenofovir for MSM who had condomless anal intercourse in the previous three months, a negative HIV test at baseline, and a negative HIV test in the preceding year (similar to the eligibility criteria in the PROUD study). Findings The introduction of such a PrEP programme with around 4,000 MSM initiated on PrEP by the end of the 1st year and almost 40,000 by the end of the 15 th year resulted in a total cost saving (£1·0 billion discounted) and led to a gain of 40,000 discounted quality adjusted life-years over an eighty-year time horizon. This result was particularly sensitive to the time horizon chosen, the cost of antiretrovirals (for treatment and PrEP), and the underlying trend in condomless sex. Interpretation This analysis suggests that the introduction of a PrEP programme for MSM in the UK could be cost-saving and produce better health outcomes over the long term. However, a reduction in the cost of antiretrovirals (including the drugs used for PrEP) significantly shortens the time for cost-effectiveness to be achieved. Funding NIHR- RP-PG-1212-20006
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              Risk of viral failure declines with duration of suppression on highly active antiretroviral therapy irrespective of adherence level.

              To model the effect of adherence and duration of viral suppression on the risk of viral rebound. Viral rebound was defined as the first of at least two consecutive viral loads greater than 400 copies/mL after initial viral suppression. The main exposures were adherence, presence of antiretroviral class resistance before rebound or censoring date, and the percentage of follow-up time with viral suppression. A total of 274 (N = 1305 [21%]) individuals experienced viral rebound. Median time of suppression before rebound was 2 years. Viral rebound was less likely to occur among those with longer duration of continuous viral suppression (odds ratio, 0.37; 95% confidence interval, 0.32 to 0.42). Among individuals with moderate levels of adherence (80% to less than 95%), the probability of virologic failure was 0.85 after being suppressed for 12 months and it was 0.08 after 72 months being suppressed (P < 0.01). Individuals with drug resistance were at a higher risk of viral rebound. The risk of viral rebound decreased with longer duration of viral suppression within each of adherence strata studied. Although perfect adherence remains an important goal of therapy to prevent disease progression, individuals with long-term viral suppression may be able to miss more doses without experiencing viral rebound.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Formal analysisRole: InvestigationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Project administrationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: MethodologyRole: ValidationRole: Writing – review & editing
                Role: SupervisionRole: ValidationRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 October 2018
                2018
                : 13
                : 10
                : e0204738
                Affiliations
                [1 ] National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
                [2 ] Universidad Complutense de Madrid, Madrid, Spain
                [3 ] La Doctora Álvarez Communication Agency, Madrid, Spain
                [4 ] Asociación CoRIS, Madrid, Spain
                [5 ] Apoyo Positivo, Madrid, Spain
                [6 ] Projecte dels NOMS, Hispanosida, Barcelona, Spain
                [7 ] Hospital Universitario Ramón y Cajal, Madrid, Spain
                [8 ] Universidad Alcalá de Henares, Madrid, Spain
                [9 ] Seisida, Madrid, Spain
                [10 ] AIDS Research Institute-IrsiCaixa, Barcelona, Spain
                [11 ] Hospital Clinico Universitario de Santiago de Compostela, Infectious Diseases Department, Santiago de Compostela, Spain
                [12 ] Centro Sanitario Sandoval IdISSC, Unidad ITS/VIH, Madrid, Spain
                [13 ] Hospital Son Espases, Palma de Mallorca, Spain
                [14 ] Grupo de Trabajo sobre Tratamientos del VIH -gTt-VIH, Barcelona, Spain
                British Columbia Centre for Excellence in HIV/AIDS, CANADA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0928-2679
                http://orcid.org/0000-0002-8309-4270
                Article
                PONE-D-18-09415
                10.1371/journal.pone.0204738
                6195256
                30339690
                cefe22a2-c09d-4650-a5c3-e8638e32fb53
                © 2018 Iniesta et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 March 2018
                : 13 September 2018
                Page count
                Figures: 0, Tables: 2, Pages: 10
                Funding
                This work has been supported by the Spanish Network of Excellence on HIV ((RIS) (RD16CIII/0002/) and CIBERESP.
                Categories
                Research Article
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Prophylaxis
                Pre-Exposure Prophylaxis
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Immunodeficiency Viruses
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Immunodeficiency Viruses
                HIV
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Retroviruses
                Lentivirus
                HIV
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                People and places
                Geographical locations
                Europe
                European Union
                Spain
                People and Places
                Population Groupings
                Sexuality Groupings
                Men WHO Have Sex with Men
                Medicine and health sciences
                Diagnostic medicine
                HIV diagnosis and management
                Medicine and health sciences
                Infectious diseases
                Viral diseases
                HIV infections
                Research and Analysis Methods
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                All relevant data are within the paper and its Supporting Information files.

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