Baseline characteristics of gay and bisexual men in a HIV pre-exposure prophylaxis demonstration project with equity quotas in Auckland, New Zealand
Peter J. W. Saxton A E , Sunita Azariah B , Richard A. Franklin B , Rose F. Forster B , Suzanne F. Werder B , Renee Jenkins B , Jason M. Myers C , Joseph G. Rich C , Whatitiri P. Te Wake C and Mark D. Fisher DA Gay Men’s Sexual Health research group, Department of Social and Community Health, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
B Auckland Regional Sexual Health Service, Auckland District Health Board, Private Bag 92024, Auckland, New Zealand.
C New Zealand AIDS Foundation, PO Box 6663, Wellesley St, Auckland 1141, New Zealand.
D Body Positive, PO Box 68-766, Wellesley St, Auckland 1141, New Zealand.
E Corresponding author. Email: p.saxton@auckland.ac.nz
Sexual Health 16(1) 47-55 https://doi.org/10.1071/SH18056
Submitted: 28 March 2018 Accepted: 8 August 2018 Published: 2 October 2018
Abstract
Background: In New Zealand, pre-exposure prophylaxis (PrEP) should target gay and bisexual men (GBM), and equity is an important principle. Baseline characteristics of GBM offered PrEP in a demonstration project with an enrolment quota of 50% non-Europeans are described. Methods: An open-label, single-arm treatment evaluation study design (‘NZPrEP’) was used. The settings were four publicly funded sexual health clinics in Auckland in 2017. The study population was 150 GBM recruited from clinics, community sources and social media. Participants self-completed an online questionnaire about PrEP awareness, attitudes and sexual risk behaviour in the last 3 months. Baseline characteristics are described and examined to determine whether these were associated with PrEP initiation status (self-referral vs doctor/nurse recommendation). Results: In total, 150 GBM of whom half (52%) were non-European, including 21.3% Maori, 19.3% Asian and 8.7% Pacific, were enrolled into the study. Two-thirds (65.3%) self-referred for PrEP and one-third (34.7%) were recommended PrEP by the doctor/nurse. Participants reported a high number of male condomless receptive anal intercourse partners (MenAICLR) (median 3, range 0–50), with 10% reporting 10 or more MenAICLR and 45.3% reporting group sex. In the previous year, 65.3% had a sexually transmissible infection (STI); 18% had rectal chlamydia or gonorrhoea at enrolment. Almost half (47.7%) had recently used drugs with sex, including 8.1% who used methamphetamine. Participants recommended PrEP had lower education, lived less centrally and had a higher STI prevalence than PrEP self-referrers, but their risk behaviour was similar. Conclusions: Early PrEP adopters in New Zealand have high HIV risk. Demonstration projects should consider equity mechanisms so that minorities can participate meaningfully.
Additional keywords: Asian, ethnicity, homosexual men, implementation, Indigenous, Maori, Pacific, targeted.
References
[1] Wang H, Wolock TM, Carter A, Nguyen G, Kyu HH, Gakidou E, Hay SI, Mills EJ, Trickey A, Msemburi W, Coates MM. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015. Lancet HIV 2016; 3 e361–87.| Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2015: the Global Burden of Disease Study 2015.Crossref | GoogleScholarGoogle Scholar |
[2] Beyrer C, Sullivan P, Sanchez J, Baral SD, Collins C, Wirtz AL, Altman D, Trapence G, Mayer K. The increase in global HIV epidemics in MSM. AIDS 2013; 27 2665–78.
| The increase in global HIV epidemics in MSM.Crossref | GoogleScholarGoogle Scholar |
[3] Grant RM, Lama JR, Anderson PL, iPrEx Study team Pre-exposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.
| Pre-exposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[4] McCormack S, Dunn D, Desai M, Dolling D, Gafos M, Gilson R, Sullivan A, Clarke A, Reeves I, Schembri G, Mackie N. 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 53–60.
| 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.Crossref | GoogleScholarGoogle Scholar |
[5] Molina JM, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, Tremblay C, Le Gall J, Cua E, Pasquet A, Raffi F. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med 2015; 373 2237–46.
| On-demand preexposure prophylaxis in men at high risk for HIV-1 infection.Crossref | GoogleScholarGoogle Scholar |
[6] World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV No. WHO/HIV/2015.36. Geneva: World Health Organization; 2015. Available online at: http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/ [verified 2 September 2018].
[7] Vaccher S, Grulich A, McAllister J, Templeton D, Bloch M, McNulty A, Holden J, Poynten I, Prestage G, Zablotska I, Carr A. Protocol for an open-label, single-arm trial of HIV pre-exposure prophylaxis (PrEP) among people at high risk of HIV infection: the NSW Demonstration Project PRELUDE. BMJ Open 2016; 6 e012179
| Protocol for an open-label, single-arm trial of HIV pre-exposure prophylaxis (PrEP) among people at high risk of HIV infection: the NSW Demonstration Project PRELUDE.Crossref | GoogleScholarGoogle Scholar |
[8] Liu AY, Cohen S, Vittinghoff E, Anderson P, Doblecki-Lewis S, Bacon O, Chege W, Postle B, Matheson T, Amico K, Liegler T. Preexposure prophylaxis for HIV infection integrated with municipal- and community-based sexual health services. JAMA Intern Med 2016; 176 75–84.
[9] Lal L, Audsley J, Murphy D, Fairley CK, Stoove M, Roth N, Moore R, Tee BK, Puratmaja N, Anderson PL, Leslie D. Medication adherence, condom use and sexually transmitted infections in Australian PrEP users: interim results from the Victorian PrEP Demonstration Project. AIDS 2017; 31 1709–14.
| Medication adherence, condom use and sexually transmitted infections in Australian PrEP users: interim results from the Victorian PrEP Demonstration Project.Crossref | GoogleScholarGoogle Scholar |
[10] Hoagland B, Moreira RI, De Boni RB, Kallas EG, Madruga JV, Vasconcelos R, Goulart S, Torres TS, Marins L, Anderson PL, Luz PM. High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project. J Int AIDS Soc 2017; 20 21472
| High pre-exposure prophylaxis uptake and early adherence among men who have sex with men and transgender women at risk for HIV Infection: the PrEP Brasil demonstration project.Crossref | GoogleScholarGoogle Scholar |
[11] Hughes AJ, Saxton P. Thirty years of condom-based HIV prevention among gay men in New Zealand. N Z Med J 2015; 128 19–30.
[12] Saxton PJ, Dickson NP, McAllister SM, Sharples K, Hughes AJ. Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period. Sex Health 2011; 8 311–8.
| Increase in HIV diagnoses among men who have sex with men in New Zealand from a stable low period.Crossref | GoogleScholarGoogle Scholar |
[13] AIDS Epidemiology Group. AIDS – New Zealand. Issue 76, May 2017. Dunedin, New Zealand; 2017. Available online at: https://www.otago.ac.nz/aidsepigroup/pdf/76_AIDS-NZ%20May%202017.pdf [verified 24 August 2018].
[14] Saxton PJ, Hughes A, Giola M. HIV prevention today: with coordinated action, we can end transmission. N Z Med J 2015; 128 8–15.
[15] Saxton PJ, Dickson NP, Hughes AJ. Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002–2011: condom use stable and more HIV testing. Sex Transm Infect 2014; 90 133–8.
| Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002–2011: condom use stable and more HIV testing.Crossref | GoogleScholarGoogle Scholar |
[16] PHARMAC. Decision to fund HIV pre-exposure prophylaxis (PrEP). Wellington, NZ: PHARMAC; 2018. Available online at: https://www.pharmac.govt.nz/news/notification-2018-02-07-prep/ [verified 17 September 2018].
[17] National HIV Forum. Consensus statement on comprehensive HIV prevention in Aotearoa/New Zealand. National HIV Forum; 2017. Available online at: https://hivconsensus.org.nz/ [verified 2 September 2018].
[18] Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, O’Donnell D, Whittaker B, Crooks L, Zablotska I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad 2017; 3 164–184.
[19] Sunita A, Franklin R, Forster R, Jenkins R, Saxton P. Protocol for the NZPrEP Demonstration Project. Auckland: Auckland Sexual Health Service; 2017.
[20] Saxton PJ, Dickson N, Griffiths R, Hughes A, Rowden J. Actual HIV prevalence and undiagnosed infections in a community sample of men who have sex with men in Auckland, New Zealand. BMC Public Health 2012; 12 92
| Actual HIV prevalence and undiagnosed infections in a community sample of men who have sex with men in Auckland, New Zealand.Crossref | GoogleScholarGoogle Scholar |
[21] ASHM. Antiretroviral Guidelines. Available online at: http://arv.ashm.org.au/arv-guidelines/prep-resources-for-clinicians [verified 2 September 2018].
[22] Statistics New Zealand. Statistical Standard for Ethnicity 2005. Wellington, New Zealand; 2005. Available online at: http://archive.stats.govt.nz/~/media/Statistics/browse-categories/population/census-counts/review-measurement-ethnicity/statistical-standard-for-ethnicity-2005.pdf [verified 2 September 2018].
[23] Vaccher SJ, Grulich AE, Haire BG, Conway DP, Poynten IM, Ooi C, Foster R, Templeton DJ, Zablotska IB, PRELUDE Study Team Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project. PLoS One 2017; 12 e0185398
| Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project.Crossref | GoogleScholarGoogle Scholar |
[24] Van Laarhoven A, Hoornenborg E, Achterbergh R, De Vries H, Prins M, Van Der Loeff MS. Changes in sexual risk behaviour among daily prep users after 6 months of use in the Amsterdam PrEP project. Sex Transm Infect 93 A20 [Abstract O09. 3]
[25] Holt M, Lea T, Mao L, Zablotska I, Lee E, Hull P, de Wit JB, Prestage G. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health 2017; 14 72–9.
| Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys.Crossref | GoogleScholarGoogle Scholar |
[26] Holt M, Lea T, Schmidt HM, Kolstee J, Ellard J, Murphy D, Truong HH, de Wit J. Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011–2015. Sex Transm Infect 2017; 93 438–44.
| Willingness to use and have sex with men taking HIV pre-exposure prophylaxis (PrEP): results of online surveys of Australian gay and bisexual men, 2011–2015.Crossref | GoogleScholarGoogle Scholar |
[27] Hoornenborg E, Krakower DS, Prins M, Mayer KH. Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries. AIDS 2017; 31 2179–91.
| Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries.Crossref | GoogleScholarGoogle Scholar |
