Cost and anonymity as factors for the effective implementation of pre-exposure prophylaxis: an observational study among gay, bisexual and other men who have sex with men in Singapore
Rayner Kay Jin Tan A D , Alvin Kuo Jing Teo A , Nashwinder Kaur B , Jack Harrison-Quintana C , Mark I-Cheng Chen A B and Chen Seong Wong BA Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549 Singapore.
B National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442 Singapore.
C Grindr for Equality, 750 N San Vicente Blvd, West Hollywood, CA 90069, USA.
D Corresponding author. Email: e0145771@u.nus.edu
Sexual Health 15(6) 533-541 https://doi.org/10.1071/SH18059
Submitted: 2018 March 30 Accepted: 2018 May 26 Published: 25 September 2018
Journal Compilation © CSIRO 2018 Open Access CC BY-NC-ND
Abstract
Background: HIV pre-exposure prophylaxis (PrEP) is currently offered by several public and private clinics at unsubsidised prices in Singapore, but to date, no information is available on the effect of these services. This study sought to assess the knowledge and uptake of, and willingness to use PrEP among gay, bisexual and other men who have sex with men (GBMSM) in Singapore. Methods: Recruitment was conducted through Grindr®, a geosocial networking application for GBMSM. Results were quantitatively analysed through descriptive statistics and multivariate Poisson regression models, while open-ended responses were qualitatively coded and categorised. Results: Of the 1339 participants who responded, 1098 participants who indicated their knowledge and use of PrEP were included in the analytic sample. Overall, 15.0% (n = 154) had taken PrEP, 66.2% (n = 678) had heard of but not taken PrEP, while 18.8% (n = 193) had never heard of PrEP. Of those who had ever taken PrEP, 59.6% (n = 90) had obtained PrEP from overseas or other unofficial sources. Of those who had heard of but never taken PrEP, 73.3% (n = 486) reported that they would consider taking PrEP. Those who had taken PrEP were older and had higher educational attainment. Conclusions: The gap between the willingness to use PrEP and its uptake may be attributed to the cost of PrEP and issues of anonymity at healthcare settings in Singapore. National financing schemes are needed to expand access to PrEP if it is to make a meaningful effect to the Singapore HIV/AIDS response.
Additional keywords: HIV, HIV prevention, primary prevention.
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