Numerous factors limit men who have sex with men (MSM) from accessing Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) according to a recent national survey, the National AIDS Treatment Advocacy Project (NATAP) reports. These factors also vary considerably depending on demographic factors.

Through two popular websites, researchers at Boston’s Fenway Health conducted a national online survey of 4,968 MSM, asking them about their sexual behavior, knowledge and use of PrEP and, if they were not on PrEP, their reasons for not using it.

Findings were presented at the 9th International AIDS Society Conference on HIV Science in Paris (IAS 2017).

Twenty-one percent of the respondents were 18 to 24 years old, 18 percent were 25 to 29, 23 percent were 30 to 39 and 38 percent were 40 or older. Forty-eight percent of the group was white, 25 percent was Black, 11 percent was Latino and 16 percent was multiracial.

Seventy-five percent of the men reported engaging in condomless sex at least twice during the previous three months. Eight percent reported condomless sex once during that period, and 18 percent reported no condomless sex.

Seventeen percent of the men reported ever using Truvada for prevention of HIV. Among non-PrEP users, about one in four had never heard of PrEP.

A total of 2,926 of the men gave reasons for not using PrEP, including: potential costs (40 percent), potential side effects (31 percent), not knowing how to access PrEP (31 percent), the potential impact on their insurance (20 percent), not feeling at risk for HIV (19 percent) and concerns about how their medical provider would react if they asked for PrEP (18 percent).

Among the 2,836 non–PrEP users who gave responses about their likelihood of taking PrEP, 15 percent said they were extremely likely to use PrEP, 24 percent said they were likely to use PrEP, 45 percent were undecided, 10 percent were unlikely to use PrEP and 6 percent were extremely unlikely to use PrEP. Sixty-five percent said they would not change their frequency of condomless sex if they started PrEP, 30 percent said they would have more condomless sex and 4.5 percent said they would have less condomless sex.

The researchers found that when they broke down the study population by various demographic characteristics and adjusted the data for various factors, they could identify certain factors associated with not using PrEP among certain subgroups.

Compared with 18- to 24-year-olds, 30- to 39-year-olds were twice as likely and those 40 and older were 2.3 times more likely to cite concerns about side effects as a reason not to want to use PrEP. Compared with those in the youngest age bracket, those in the other two age brackets were each 30 percent less likely to cite access concerns.

Compared with those born in the United States, those born outside of the country were 1.4 times more likely to cite access concerns.

Compared with Blacks, whites were 1.4 times more likely to cite access concerns and 40 percent less likely to cite both cost and insurance concerns.

Compared with those not in a monogamous relationship, those in such a relationship were 1.8 times more likely to cite a lack of perceived risk for HIV, 30 percent less likely to cite cost and 40 percent less likely to cite side effects.

Compared with those who reported no condomless sex during the previous three months, those who did report such sex were 1.5 times more likely to cite cost and 1.4 times more likely to cite access concerns. And compared with those reporting no recent condomless sex, those who reported condomless sex twice or more in the previous three months were 1.3 times more likely to cite concerns about cost, 1.3 times more likely to cite access and 1.3 times more likely to cite insurance, and 50 percent less likely to cite no perceived risk of HIV.

Compared with men with a high school education or less, those in four higher brackets of educational attainment cited cost concerns at a factor ranging from 1.4- to 2.1-fold higher and side effects at a factor ranging from 1.4- to 1.8-fold higher and were less likely to cite access as a concern at a factor ranging from 50 to 30 percent less.

To read the NATAP report, click here.