A study of men who have sex with men (MSM) conducted by the
European Centre for Disease Control and Prevention (ECDC) in collaboration with
the gay contact site Hornet has found that PrEP usage has not increased, on
average, among its respondents over the proportion reported last year, when a
similar survey was made
.

The results were presented recently at the 16th European AIDS
Conference
.

It found that 10% of its respondents were currently taking
PrEP, though this varied from hardly any in some countries to 17% in the case
of Ukraine.

Other countries where higher numbers of respondents were
taking PrEP included Turkey (16%) and Sweden (15%). The proportion in the UK
was the survey average, 10%, with no increase since last year.

Although PrEP usage in France was 11% and Russia was 8%, there
were a large number of French and Russian replies so numerically, French PrEP
users represented 27% of all those reporting PrEP use and Russians 18%.

The ECDC’s Teymur Noori told the conference that the survey
ran for a month in July and August 2017. Altogether 12,053 men responded, with replies from every
one of the 55 countries of the WHO European region.

Noori prefaced the survey by noting that although HIV
infections among MSM were starting to fall in some countries, the annual number of new HIV diagnoses in MSM had risen by 16% in the last decade throughout the
European Union and European Economic Area (EU/EEA: this excludes most of the
former Soviet states). Diagnoses in all other groups has fallen.

Although PrEP was slowly being introduced in more countries, progress
was slow, Noori said. The cost of PrEP was overwhelmingly cited as the main barrier to
adopting it, with two-thirds of 36 nations in the EU/EEA mentioning cost as a
principal barrier. In the face of national health systems’ unwillingness to
spend on PrEP, the survey provided evidence that MSM throughout the European
region were attempting to access it in other ways.

France and Russia drew the most responses to the survey, with
nearly half of survey respondents coming from these two countries (23% each).
The other three countries in the ‘top five’ of responses were the UK (13%),
Italy (8%) and Turkey (6%).

Participants were generally young; 75% were under 40 and 28%
under 25. Eleven per cent of participants had HIV, the same as in the last
survey (ranging from 19% in Portugal to 7% in the UK) and 9% said they did not
know their HIV status. These were excluded from the analysis of answers about
PrEP. This left 10,038 men who said they were sure they were HIV-negative, of whom 1056 said they were currently taking PrEP.

Of these, roughly a third each said they had it prescribed by
their doctor (36%) or bought it online (32%). The 27% of French respondents on
PrEP represented the majority who said they had it prescribed; Noori said the
other 9% would be partly due to new rollout programmes in other countries and
partly due to physicians prescribing off-label generic PrEP in the mainly
eastern countries where Truvada is
not patented.

Thirteen per cent of respondents said they received PrEP as
part of a study, another 13% acquired it from friends, and 5% said they got it
by requesting PEP (post-exposure prophylaxis). This meant that roughly half the
respondents were accessing PrEP from physicians and half were getting hold of
it informally. Incidentally, 48% of those currently on PrEP said they had
received PEP during the last year, indicating that it may be a ‘gateway’ to
PrEP use.

One-third said their doctor did not know they were taking PrEP
and thus must be presumed not to be receiving adequate medical monitoring.

Unsurprisingly 85% of those currently on PrEP (621
respondents) said they intended to continue taking it within the next year. In contrast only 22%
of those not on PrEP said they were likely to start during the year (1969
respondents), and they were outnumbered by 35% (N=3132) who said they would
definitely not take it in the next
year.

People taking PrEP were in the main getting tested regularly
for sexually transmitted infections (STIs); 87% (690 respondents) had had an
STI checkup in the last year and 48% of them (N=277) had been diagnosed with an
STI. STI checking was pretty high in respondents not on PrEP too, with 69% (8613
men) saying they had had an STI checkup during the year and 17% (N=975)
diagnosed with an STI.

Use of sex-associated ‘Chemsex’ drugs (mephedrone, GHB/GBL, ketamine,
methamphetamine) within the last three months was reported by 28% of PrEP users
(N=190) but only 5% of non-users (N=425).

Noori commented that these figures showed that PrEP was
largely being accessed by the people who needed it most, namely those at the
highest risk of HIV.

One interesting finding was that PrEP users were generally
happier with their sex lives, possibly, Noori commented, due to lower rates of
anxiety. Seventy-six per cent of PrEP users were happy with their sex life and
only 10% unhappy: in contrast 54% of non-users were happy and 28% unhappy.

Noori concluded by noting that formal PrEP roll-out is still slow
in the European region; that there was evidence of significant informal PrEP
use across European countries; and that a significant number of men using PrEP
informally are still doing so without informing their sexual health providers.