PEP talk: awareness of, and access to post-exposure prophylaxis among gay men and bisexual men in the UK
Since 2003, Making it Count, the HIV prevention planning framework for homosexually active men in England and Wales has included aims concerning access to post-exposure prophylaxis (PEP) after sexual exposure to HIV. UK clinical guidelines for prescribing PEP following sexual exposure were drafted in 2004 and finalised in 2006. An PEP information campaign for Gay men and Bisexual men was launched by Terrence Higgins Trust for CHAPS in 2004 in London and Brighton, and rolled out across England and Wales in 2005.
In 2003 the Gay Men's Sex Survey (GMSS) included a series of questions about PEP including: had men heard of it; had they tried to access it; had they taken it; did they know anyone who had taken it; and (if not tested positive) would they consider using it if they were involved in HIV exposure. GMSS 2005 repeated the same questions. Taken together, this data demonstrated the extent to which homosexually active men had become more familiar with the concept of PEP following sexual exposure. There was an overall increase in the proportion of men who: had heard of PEP, from 23.6% to 39.9%; had ever tried to access PEP, from 1.0% to 1.5%; had ever taken PEP, from 0.7% to 1.2%; and who knew someone who had taken PEP, from 5.3% to 6.5%. Detail about variation across population sub-groups in these measures is available in the final report. While it is not possible to attribute changes in population-level awareness and uptake solely to the CHAPS information campaign this is likely to have had a significant effect.
The second component of the project was based on a qualitative investigation into Gay and Bisexual men’s experiences of trying to access PEP in England and Wales. The sample was drawn from those men who indicated an interest in talking about their experiences of trying to access PEP after completing the survey online in 2005. Thirty men were interviewed by telephone about the specific circumstances that led them to seek PEP, how they knew about it, what they did before asking for it, and a detailed account of what happened when they presented for PEP in a clinical setting. Thematic analysis of these individual accounts offers detailed insights into the different ways that men come to know about PEP and seek support following risk incidents, as well as revealing the disparities in service provision across England and Wales. Not all of the men who received PEP reported satisfactory experiences with health care and reception staff, and some were inappropriately refused treatment, or attended clinics where staff were unaware of the existence of PEP.
The study was undertaken as part of the Basic Research strand of our CHAPS contract with Terrence Higgins Trust. The study informed the CHAPS PEP intervention.
The final report includes a series of practical recommendations aimed at improving service delivery, advice and information for men seeking PEP following potential sexual exposure to HIV. It was called PEP talk: awareness of, and access to post-exposure prophylaxis among gay and bisexual men in the UK.
Key contact: Catherine Dodds