Awareness and acceptability of pre-exposure prophylaxis among MSM: results from Scotland’s gay bar survey

Scotland was the first country to introduce free criterion-based PrEP for all citizens. So far, uptake has been almost exclusively among MSM. Herein, we examine PrEP awareness and acceptability among MSM in Scotland from a national level behavioural surveillance project. Time and location sampling was used to survey n=972 MSM across the commercial gay scenes of Scotland’s two largest cities. 5.4% of participants were HIV+. 94.6% were HIV-/untested, of whom, 4.5% were on PrEP. Most of the remaining men had heard of PrEP (81.7%). Multivariate logistic regression suggested that gay men (OR=2.76), men aged 26-35 (OR=2.38) and 36-45 (OR=2.31), men who used the gay scene >=twice a month (OR=2.19), reported an HIV test in the last year (OR=1.96) or an STI other than HIV diagnosed in the last year (OR=3.47) were significantly (p<0.05) more likely to have heard of PrEP. Around one third (31.1%) of HIV-/untested men said they were likely to use PrEP now it is available. Multivariate logistic regression suggested that gay men (OR=2.23), younger men (18-25, OR=2.73; 26-35, OR=2.48; 36-45, OR=2.00), single men (OR=2.08), men who use the gay scene >=twice a month (OR=1.51), men who report high risk condomless anal intercourse (OR=1.61), an HIV test in the last year (OR=1.95) or an STI other than HIV diagnosed in the last year (OR=1.61) were significantly more likely to consider using PrEP in the future. PrEP awareness among MSM in Scotland is high, but disparities in awareness remain along traditional indicators of inequality. Findings suggest substantial interest in PrEP, particularly among those most likely to benefit although other issues may be more indicative of use than pure behavioural risk. As the biobehavioural HIV risk management strategies now available to MSM require high levels of health literacy, health promotion strategies must focus on enabling men to negotiate these complexities.