Delivered at Sex, Drugs & Scotland's Health Virtual Conference, this presentation was delivered by Dr Jamie Frankis. More information about the virtual event is available here: http://ow.ly/YntW50GWhJ0

1. 13/10/2021
1
Adiós HIV: Are PrEP and other biobehavioural sexual
risk management strategies ending HIV in Scotland?
Dr Jamie Frankis1, Dr Demi Strongylou1
Ross Kincaid1, Prof Paul Flowers2
1 GCU, Scotland, UK
2 University of Strathclyde, UK
Biobehavioural Risk management and HIV
• 80’s Simple Message - Wear a condom, every time
• Now - complex behavioural strategies and biomedical
technologies
• Today I’m going to focus on biobehavioural risk
management for HIV- GBMSM
• What steps are needed to say Adiós to HIV?

2. 13/10/2021
2
Biobehavioural HIV Risk management Strategies
- No sex (!) with other people
- No anal sex
- Condoms for anal sex
- Negotiated safety – condomless anal sex with a
regular HIV negative partner
- Serosorting – only having sex with HIV- men
- Treatment as prevention – condomless anal sex with
one HIV+ regular partner with undetectable viral load
- PrEP – anti-HIV medication daily / intermittently
Biobehavioural HIV Risk management
• What biobehavioural HIV risk management
strategies do GBMSM in Scotland use?
• How can PrEP and HIV testing mitigate any risks
that still remain?

3. 13/10/2021
3
Methods
• SMMASH Surveys (Social Media, MSM, Sexual
Holistic Health)
– Sexual, mental & wider health
• SMMASH3, pre C19, Dec 2019– March 2020
• Asked men about regular and casual sex
partners in detail as well as HIV testing & PrEP
• A total of n=583 men in Scotland took part
Results
• 6.5% of participants were HIV+
• 93.5% were HIV-/untested (n=532)
• Focus on these 532 HIV-/Untested men
• Most (94.6%) had heard of PrEP

4. 13/10/2021
4
Results – Biobehavioural Strategies
• HIV Sexual Risk Behaviours
• Lower Risk Behaviours – 67.9%
• Higher Risk Behaviours – 32.1%
Results – Lower Risk Behaviours – 67.9%
• PrEP – 24.1%
Not on PrEP but safer
• No condomless anal sex – 34.8%
• Negotiated Safety – 7.0%
• Treatment as Prevention – 0.2%
• NS & TasP with 2+ regular partners 1.9%
• Serosorting and TasP with 1 regular and 1
casual partner – 1.1%

5. 13/10/2021
5
Results - Higher Risk Behaviours – 32.1%
Mitigated by PrEP – 23.1%
• CAS 2+ casual partners – 5.6%
• CAS 1 regular, 2+ casual partners – 7.3%
• CAS 2+ regular, 2+ casual partners – 6.0%
• Serosorting and/or TasP with multiple casual
and/or regular partners – 4.2%
HIV Testing – 8%
• CAS 1 regular, status unknown partner – 7%
• CAS 2+ regular, status unknown partners – 0.9%
Results – PrEP Candidates?
• 23.1% High risk behaviours that could be
mitigated by PrEP
Of these men
• 15.5% had been offered PrEP in previous year
• 62.6% met current Scottish PrEP Guidelines

6. 13/10/2021
6
Conclusions
Biobehavioural Risk Strategies are complex!
• Key strategies used in Scotland are
i) no CAS, ii) Negotiated Safety, iii) PrEP
• About ¼ of risk takes place in regular relationships
Highlights centrality of HIV testing & risks in relationships
Almost ¼ of men in sample on PrEP
• About ¾ of our higher risk men could benefit from PrEP
Huge impact and potentially further benefit of PrEP
Widening criteria for PrEP?
Invite critical engagement with the biobehavioural risk
criteria presented
• Find out more about the SMMASH study at our website
https://www.smmash2020.org
Thanks to the SMMASH participants,
our funders and all our co-researchers on the project

7. 13/10/2021
7
STI diagnoses and testing pre/post PrEP
among Gay, Bisexual and other men who
have sex with men (GBMSM) in the UK
and Ireland
Dr Demi Strongylou and Dr Jamie Frankis
GCU, Scotland, UK
STI Testing in GBMSM
• Frequent STI testing is critical to decrease STI
diagnoses among GBMSM.
• This study examines STI diagnoses and testing rates
among GBMSM in the UK & Ireland
• Data drawn from the SMMASH studies
• SMMASH2 – June 2016
• SMMASH3 – Dec 2019 – March 2020
• Considered HIV+, HIV-/status unknown, PrEP users
and men reporting higher risk sex separately.

8. 13/10/2021
8
STI Testing – Results
HIV+ GBMSM
• No changes over time
• Most reported STI testing in the last year
2016 79% vs 2020 80%
• Same proportions reported recent STI diagnosis in the
last year (other than HIV)
2016 32% vs 2020 32%
STI Testing – Results
HIV-/status unknown GBMSM
• No changes over time
• Increased STI testing over time
2016 44% vs 2020 52%
• Increased in recent STI diagnosis (other than HIV)
2016 21% vs 2020 25%

9. 13/10/2021
9
STI Testing – Results
PrEP Users
• Tiny numbers of PrEP users in 2016 so no comparison
• Very high levels of testing in 2020
• Near-universal STI testing
• 2020 85%
• High rate of STI diagnosis (other than HIV)
• 2020 40%
STI Testing – Results
Men reporting Higher HIV risk sex behaviours
• Decreased over time
• Decreased STI testing over time
2016 60% vs 2020 51%
• Decrease in recent STI diagnosis (other than HIV)
2016 % 33% vs 2020 22%

10. 13/10/2021
10
STI Testing – Discussion
• Free PrEP provision requires regular STI testing
• Recent STI testing has decreased among GBMSM
reporting higher HIV risk sex
• Impact of PrEP provision on other STIs
• Impact of the pandemic on STI screening services