Poster presentation at the AIDS 2018 conference in Amsterdam. By: Adam Bourne1, Beatrice Alba1, Alex Garner2, Gianfranco Spiteri3, Anastasia Pharris3, Teymur Noori3 1. Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia; 2. Hornet Gay Social Network, California, USA; 3. European Centre for Disease Prevention and Control, ECDC, Sweden

1. Adam Bourne1, Beatrice Alba1, Alex Garner2, Gianfranco Spiteri3, Anastasia Pharris3, Teymur Noori3
1. Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia; 2. Hornet Gay Social Network, California, USA; 3. European Centre for Disease Prevention and Control, ECDC, Sweden
Background
• Pre-exposure prophylaxis (PrEP) has the potential to radically alter the trajectory
of the HIV epidemic in Europe (1), where the highest number of new diagnoses
occur among men who have sex with men (MSM) (2).
• Despite convincing evidence for the efficacy of PrEP, rollout and national
provision across Europe remains relatively low.
• A number of websites and advocacy platforms across the continent have sought
to facilitate access to PrEP online, typically sourced from pharmacies in Thailand
and South Africa.
• While demonstration projects provide an indication of the number of men using
PrEP in those countries where these are active, there are few other national or
regional estimates of the proportion of gay, bisexual and other MSM (GBMSM)
using PrEP that take into account those accessing it informally in online
environments.
• There are also few regional estimates of willingness to use PrEP, data which are
fundamental to resourcing and design of uptake interventions.
The use, and likelihood of using, HIV pre-exposure prophylaxis
among men who have sex with men in Europe and Central Asia:
findings from a 2017 large social networking application survey
Methods
A survey was sent out in eight languages (Arabic, English, French, German, Italian,
Portuguese, Russian and Spanish) to users of the Hornet gay networking application
in July and August 2017.
Participants were eligible if they self-reported to be male, were aged 18 years and
above, identified as a man who has sex with other men, and lived within the 55
countries of Europe and Central Asia according to the UN country classification
system. Data were collected relating to:
• HIV status and recency of HIV testing
• PrEP use currently or within the previous 3 months
• Willingness to use PrEP in the next 6 months (Likert scale 1-5)
• Indicators of PrEP candidacy (diagnosis with an STI or post-exposure
prophylaxis (PEP) use within last 12 months, engagement in chemsex in last 3
months)
Results
The sample
• In total, 12,053 eligible men completed the survey, of whom 1,289 (10.7%) reported being HIV
positive. These men were excluded from the following analysis, leaving a final sample of 10,562
HIV negative or untested men.
• Respondents came from 54 countries of Europe and Central Asia, including: France (n=2,544,
24.1%), Russia (n=2,393, 22.7%), United Kingdom (n=1,414, 13.4%), Italy (n=797, 7.5%) and
Turkey (n=617, 5.8%).
Current or recent use of PrEP
• One in 10 men (n=1,071, 10.1%) were currently taking PrEP, or had done so in the previous
three months. Men aged 41-50 years were most likely to be using PrEP (13.2%), whereas men
aged 18-25 years were least likely (13.2%). Use varied by country, as shown in Figure 1.
• Nearly half (47%) of men were accessing PrEP informally (i.e. outside of clinician prescribing in
healthcare or research settings.
• PrEP use was highest among those diagnosed with an STI or who accessed PEP in the previous
12 months, or those who had engaged in chemsex in the previous 3 months (Table 1).
• Nearly a third had not disclosed their use of PrEP to their sexual health physician/doctor.
Conclusions
• Approximately 1 in 10 men were using PrEP, with significantly higher proportions or users in
France, Russia and the United Kingdom.
• Nearly a quarter of those using PrEP has acquired PrEP online, while a further 10% had
acquired it from friends.
• Regardless of the means by which they were accessing PrEP, analysis of their HIV risk profile
indicates they are ideal candidates for doing so, and thus do not constitute a ‘worried well’.
• Men currently using PrEP were significantly more likely to report happiness with their sex life
than men who were not. This finding may prove valuable in social marketing and other
efforts that seek to increase the uptake of PrEP among MSM.
• There is considerable interest in using PrEP among MSM across Europe and Central Asia,
especially among those who have a higher HIV risk profile.
• Further efforts should be considered to ensure safe and affordable access to PrEP, ideally
provided as part of a comprehensive sexual health service targeting the needs of MSM.
CONTACT: Teymur.Noori@ecdc.europa.eu
www.ecdc.europa.eu www.Latrobe.edu.au/arcshs www.hornet.com
CONTACT: Teymur.Noori@ecdc.Europa.eu
www.ecdc.europa.eu www. Latrobe.edu.au/arcshs www.hornet.com
Acknowledgments: We are grateful to Will Nutland of Prepster for helpful comments on an earlier draft of
this paper; Sheena McCormack for providing input on the content of the survey questions; Lella Cosmaro
and Ulrich Marcus for support in translating the survey.
n(%)
Currently
taking
PrEP
n
Not
currently
taking
PrEP
n
Odds ratio
Unadjusted Adjusted
OR [95% CI] p value OR [95% CI] p value
PEP use (last 12 months)
Yes
No
n=9,750
773 (7.9)
8,977 (92.1)
334
416
439
8561
15.66
[13.17, 18.62]
<.001 16.22
[13.53, 19.45]
<.001
STI diagnosis
(last 12 months)
Yes
No
n=6,314
1,261 (20.0)
5,053 (80.0)
280
298
981
4755
4.55
[3.82, 5.44]
<.001 4.53
[3.77, 5.44]
<.001
Chemsex (last 3 months)
Yes
No
n=9,185
622 (6.8)
8,563 (93.2)
190
490
432
8073
7.25
[5.97, 8.79]
<.001 7.19
[5.86, 8.82]
<.001
Happy with sex life?
Very unhappy
Unhappy
Not sure/don’t know
Happy
Very happy
n=9,208
440 (4.8)
2,000 (21.7)
1,655 (18.0)
3,843 (41.7)
1,270 (13.8)
8
59
97
322
197
432
1941
1558
3521
1073
1.77
[1.63, 1.93]
<.001 1.73
[1.59, 1.89]
<.001
17%
16%
15%
13%
12%
11%
10%
10% 10% 10%
9%
9%
8%
7% 7%
6% 6% 6%
5%
3%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Average 10%
Table 1. Binary logistic regressions predicting current PrEP use (or use in the previous 3 months).Figure 1. Proportions of men in each country currently using PrEP use (or reporting use in the previous 3 months)
69%
31% Yes
No
Where did you obtain PrEP?
Does your sexual health doctor
know you are taking PrEP?
Willingness to use PrEP
• To what extent to do you agree with the following statement, “I am very likely to use PrEP
in the next 6 months”
• Overall, 2,547 (33.2%) of men agreed or strongly agreed that they were likely to use
PrEP in the next six months.
• Of the men who were not current PrEP users, 926 (22%) agreed or strongly agreed that
they were likely to use PrEP in the next six months, while the figure was 85.0% (n=621)
among those currently using PrEP.
• When adjusting for age, country of residence, and current PrEP use as covariates,
likelihood of future PrEP use was significantly higher for:
 Men who had used PrEP in the previous 12 months
 Men who had received an STI diagnosis within the previous 12 months
 Men who had engaged in chemsex during the last three months.
22%
44%
35%
Not on PrEP
(n=8949)
Agree/Strongly agree
Not sure/don't know
Disagree/Strongly disagree
85%
11%
4%
On PrEP
(n=731)
Agree/Strongly agree
Not sure/don't know
Disagree/Strongly disagree
References
1. McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, et al. Pre-exposure prophylaxis to prevent the acquisition of
HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet.
2016;387(10013):53-60
2. European Centre for Disease Prevention and Control/WHO Regional Office for Europe. HIV/AIDS surveillance in Europe 2017 –
2016 data. Stockholm: ECDC; 2017.