1. Investigating attitudes towards HIV Pre-exposure Prophylaxis
A questionnaire study in men who have sex with men attending sexual health clinics
Lauren Bull, Pavle Dimitrijevic, Alex Scarborough, Sophie Beverley,
Tristan Barber, Iain Reeves, Sheena McCormack, Michael Rayment
Thank you , im delighted to present the results of this questionnaire study regarding prep

2. Background
PROUD study demonstrated that use of PrEP affords a relative reduction of 86% in the incidence of HIV
Anecdotal evidence of service users acquiring PrEP
NHS England decision(s)
Investigate attitudes towards, and experience of PrEP
There is now a fairly substantial evidence base regarding the efficacy of prep and last year the proud and ipergay studies provided evidence of real world effectiveness with an 86% reduction in hiv incidence. Last year we presented data from an anonymous survey of service users acquiring hiv medication to use as prep. With the recent decision from nhs England regarding prep, its widespread provision remains elusive currently. We undertook this study to provide further insite into service users attitudes towards prep and whether there were any demographic or behavioural data that would predict particular opinions.

3. Method
Prospective questionnaire study of self selecting HIV negative men who have sex with men attending multiple genitourinary clinics in urban settings.
November 2015 to April 2016
This was an ethically approved prospective questionnaire study of self selecting hiv neg msm in a no sites in London. This survey was available at different times between nov-april,

4. Results 664 questionnaires 20 discarded N=644 Average age: 38 (18-78)
Sexuality
Percentage of respondents (N)
Gay/homosexual
90.5% (583)
Bisexual
7.3% (47)
Straight/heterosexual
1.2% (8)
Other
0.9% (6)
In this analysis 664 questionnaires were available. Once inappropriate forms were discarded N=644 average age was 38, the majority identified as homosexual.

5. Educational Attainment
Education level
Percentage of respondents (N)
University degree or above
79.0% (493)
Higher school/ A levels
11.5% (72)
High school/GCSE/O levels
4.2% (26)
Still in education
2.7% (17)
No qualifications
2.1% (13)
Other
0.5% (3)
The educational breakdown is as follows, with 79% holding a degree

6. Country of Birth/Ethnicity
72 different countries
50% UK born, 25% European
78% white
72 different nationalities were represented, half were uk born and an additional 25% hailed from European countries. 78% white: so to emphasise the majority of these respondents are highly educated, white, uk or european born males.

7. NUMBER OF PARTNERS IN LAST MONTH Mean (Range)
Sexual Activity
88% (567/624) anal sex in the last month
59% (366/620) had at least one UPAI in the last month
NUMBER OF PARTNERS IN LAST MONTH Mean (Range)
YOUR POSITION
Total number
Number without a condom
Top / active
 4.2 (0-80)
 1.6 (0-30)
Bottom / passive
 3.8 (0-90)
 1.3 (0-20)
The overwhelming majority reported anal sex in the last month

8. HIV STATUS OF YOUR PARTNER HIV STATUS OF YOUR PARTNER
Perceived Risk
YOUR POSITION
HIV STATUS OF YOUR PARTNER
HIV+ and not on meds
HIV+ and on meds
HIV NEG
HIV status not discussed
Top / active
Bottom / passive
YOUR POSITION
HIV STATUS OF YOUR PARTNER
HIV+ and not on meds
HIV+ and on meds
HIV NEG
HIV status not discussed
Top / active
7.1
3.3
 1.2
 6.2
Bottom / passive
8.9
4.3
 1.4
 7.4
We wanted to gauge the risk people associated with anal sex in different circumstances therefore we asked them to fill in this table stating on a scale of 1-10 the risk they associated with each sex act (1 being low)
Trend passive higher risk, most understand preventative effects bein gon meds but risk still relatively high, decreased risk when on meds-unknown high risk

9. Drugs 53% (342/642) taken recreational drugs in last three months
Percentage of respondents taken
Amphetamine
11% (37/342)
Poppers
42% (143/342)
Ecstasy
27% (94/342)
Ketamine
14% (48/342)
G/GHB/GBL
43% (147/342)
Crystal meth
15% (56/342)
Mephedrone
59% (202/342)
Crack
1% (5/342)
Cannabis
27% (91/342)
Viagra/Cialis
37% (125/342)
Cocaine
40% (138/342)
28% (177/642) used drugs for sex (chemsex)
6% (21/342) injected
Median last sober sex: 1-2 weeks (range <1/52->3/12)
Over half reported recent drug use in the last 3/12. proportion for g crystal mephedrone pretty high-percentage actually reporting chem sex lower still significant at 28% 6% reported ijecting drug use (all chemsex drugs) No sharing equipment. The last sober sex ranged from a few dyas to several months.

10. STIs 40.5% (241/595) had STI in last 6 months
Sexually Transmitted infection
Proportion of respondents with STI
Chlamydia/Gonorrhoea throat/penis
27% (165/595)
Chlamydia/Gonorrhoea rectum
15% (91/595)
LGV
1% (6/595)
Syphilis
6% (38/595)
Hepatitis C
0.5% (3/595)
40% reported an sti in the last 6/12 with c/g the most common infection. 6% also acquired syphilis

11. Last HIV Test Time since last HIV test Percentage of respondents
<3/12 Months
63% (356/563)
3-6 Months
37% (207/563)
6-12 Months
12% (70/563)
1-2 Years
5% (28/563)
>2 Years
0.4% (2/563)
Vast marjoity of respondents had undergone iv testing within the preceeding 3/12 of their visit to clinic that day.

12. PEP Use 36% (212/596) have used PEP before
22% (134/596) in the last year with median frequency 1 (1-12)
Perceived effectiveness of PEP: 85% (153/181) rated PEP as very or completely effective
36% had previous use of pep with nearly a quarter in the preceeding year. We then asked them to state how effective they thought pep was ….

13. PrEP 79.8% (509/638) had heard of PrEP
So in summary thus far we have a highly educated predominantly white group of men of whom the majority report upai , nearly half report sti, significant mount drug use and nearly a quarter used pep in last year. Therefore represents a reasonably high risk group. 80% have heard of prep

14. How effective do you think PrEP is likely to be when taken as instructed? (N=550)
Not very effective
Completely effective
Asked some questions on a likert scale of representing their agreement with a number of statements. The majority of respondents view prep as being highly effective-probably aware of research results.

15. I think I would benefit from taking PrEP (N=539)
19% no UPSI
Completely Disagree
Completely Agree
Then asked whether respondents thought they would benefit from taking prep (40%) rated this as 10/10, and (63%) /10(38/ /338 ) we noticed that 18% of these however reported no upai. Vast majority reposndents agreed that they would benefit from prep however initial analysis 19% of those with high perceived benefit from prep of these had no upai. To investigate this further wanted to see If there were any independent factors that influenced the likelihood of agreeing with this statement. we used the mean reposnse to create a dichotomous category of agreeing or disagreeing with this statement and then undertook univariate and multivaritate logistic regression analysis to see if any variables independently predicted liklihhod of thinking prep would be beneficial

16. Multivariable logistic regression model
Odds Ratio (95% CI)
p-value
UPRAI
1.45
(1.00 to 2.11)
0.048
Perceived risk of UPRAI
1.41
(1.05 to 1.89)
0.022
Perceived effectiveness of PrEP
1.65
(1.17 to 2.32)
0.002
Multivariate analysis shows when adjusting for potential confounders, the people who demosntrate high risk behaviour, understand the risk of behaviour and have the most belief in prep effectiveness most likely to think they would benefit from prep

17. I think PrEP should be available to anyone who wants it 63% (353/557)
Agree
Not sure
I think PrEP should be available for free in sexual health centres to men who have sex with men
 85% (481/565)
9% (52/565) 
I think PrEP should be available for free at all NHS locations to men who have sex with men
 75% (420/564)
 16% (89/564)
I think PrEP should be available to anyone who wants it
 63% (353/557)
 18% (100/557)
I think there should be a prescription charge for PrEP in most cases
 32% (180/555)
 26% (142/555)
Number of questions regarding access and provision of prep respondents were asked to agree/disagree or state not sure

18. Preference for PrEP (N=479)
Respodnents were asked on their preference of prep regimen 55 %wanted daily ,versus 42% before/after sex few stated other other however only one person wrote weekly
Daily 263
Before/after sex 200
Not applicable 54
Other 16 (1x weekly)

19. Use of PrEP 7.0% (38/543) taken PrEP before Duration of PrEP
Number of respondents (%)
Up to 1 Month
17 (50%)
1-6 Months
10 (29%)
6-12 Months
1 (3%)
>12 Months
6 (18%)
PrEP Regimen
Number of respondents (%)
Daily
32 (84%)
Before/After sex
5 (13%)
Other
1 (3%)
Then looked at who was already taking prep. Since this study now a number of dedicated clinic services to prep users so likely to get much more significant data from these. 4 cant remember how long

20. Number sexual partners 3 (8%) 10 (28%) 23 (64%) Condom use 6 (17%)
Increased (%)
Decreased (%)
Same (%)
Number sexual partners
3 (8%)
10 (28%)
23 (64%)
Condom use
6 (17%)
11 (31%)
19 (53%)
Sexual Position
Number of respondents (%)
Top More
4 (11%)
Bottom More
5 (13%)
Stayed Same
28 (76%)
Source of PrEP
Number of respondents (%)
PEP
19 (54%)
Research
5 (14%)
Private in UK
4 (11%)
Friend/Partner
Online
3 (9%)
Numbers of sexual partners and condom use is not reported to have changed vastly. This has not been subject to statistical analysis given small numbers involved. Of people taking > yr 4/6 research 1 pep 1 friend

21. Discussion Group of high risk MSM demonstrating good awareness of PrEP
High levels of expected personal benefit particularly amongst those reporting UPRAI
Limitations: Self selecting, no response rate, incompletion, highly educated homogenous group
Limitations: Don’t have response rate, some questions missed, self selecting, highly educated homogenous group. 300 people to add
Unvlaidted qu

22. Acknowledgements
C&W: Michael Rayment, Tristan Barber, Eleanor Hamlyn, Kathryn Stacey Homerton: Iain Reeves, Sifiso Mguni, Rebecca Clark PROUD Network: Sheena McCormack, Mitzy Gafos, Monica Desai, Ann Sullivan, David Dolling, David Dunn PHE: Adamma Aghaizu
This study was completed budgetless! Therefore I would like to take this opportunity to extend my sincere thanks to the following people for erring questionnaire completeion and also to member of the proud network for their assistance in questionnaire design.