Saying "Yes" to PrEP: Examining PrEP acceptance among urban men who have sex with men (MSM) at a Seattle public sexual health clinic.

Abstract

Pre-exposure prophylaxis (PrEP) is extremely effective at preventing HIV, but uptake has been below targets. PrEP acceptance and uptake are commonly examined through hypothetical acceptability and active use, but the act of accepting a PrEP recommendation from a clinical provider is under-studied. This cross-sectional study used patient survey data and health records from the Public Health—Seattle & King County Sexual Health Clinic in Seattle, WA to examine how PrEP acceptance differed by key covariates among men who have sex with men (MSM). Among 1721 patient visits where a provider recommended PrEP to an MSM, PrEP was accepted at 1168 (68%) visits. Prevalence of PrEP acceptance was lower among patients aged 25 years or older compared to patients under age 25 (PR = 0.92, 95% CI = 0.85, 0.99) and higher among patients who reported greater numbers of recent sexual partners compared to those reporting one or fewer (PR = 1.38 95% CI = 1.13-1.68), but was lower among Black patients compared to White patients (61%, PR = 0.85, 95% CI = 0.76-0.96) and patients identifying as bisexual compared to those identifying as gay (PR = 0.84, 95% CI = 0.75-0.93). According to visit notes recorded by providers, patients who declined commonly believed their risk of HIV exposure was too low to warrant daily PrEP, were concerned about side effects, or preferred to discuss with their primary care provider, while some preferred to abstain from sex altogether following the HIV/STI exposure which brought them to the clinic. To increase PrEP uptake, future work should identify and test strategies to maximally support some MSM who have an indication for but less often accept PrEP.