Interest and Use of PreExposure Prophylaxis (PrEP) in a U.S. Representative Sample of Gay and Bisexual Men

Background: With proper adherence, PrEP is an effective biomedical strategy for reducing HIV among gay/bisexual men (GBM). However, differences between GBM taking PrEP, those willing/interested in PrEP, and those unwilling to consider PrEP, are unknown.

Methods: An online survey administered to a nationally representative sample of 853 GBM in January-February, 2015.

Results: Overall, 6% of GBM were currently prescribed PrEP, 53% expressed willingness to use PrEP, and 41% were unwilling. Condomless anal sex (CAS) was reported by 73% of PrEP users, 49% of those willing, and 24% of those unwilling (p<.001); GBM reporting CAS had higher odds of being prescribed PrEP than those willing (OR=2.9, p=.001) and unwilling (OR=8.9, p<.001). Despite behavioral differences, imagined and actual risk compensation did not significantly differ - 40% of PrEP users said it had no impact on temptation for CAS (vs 36% of willing and 44% of unwilling men) and 54% said PrEP increased temptation for CAS (vs 52% of willing and 46% of unwilling men).

Conclusions: Although only 6% of GBM in this national sample are prescribed PrEP, the majority (53%) are willing to take it. As nearly half of those willing to use PrEP report recent CAS, it is even more critical to facilitate access and uptake of PrEP among GBM. Though about half of GBM believed PrEP would increase temptation for CAS, imagined and actual risk compensation did not differ, suggesting men may be accurately anticipating impact of PrEP on CAS and that interventions designed to address temptation may be warranted.