Understanding the acceptability of pre-exposure-prophylaxis (PrEP) for HIV prevention amongst men who have sex with men (MSM) in Scotland, Wales, Northern Ireland and Republic of Ireland: a mixed methods study

Jamie Frankis, Ingrid Young, Lisa McDaid, Paul Flowers

Research output: Contribution to conferencePoster


Background: Clinical trials suggest that PrEP is highly effective if taken regularly. While not currently available within the UK, there is considerable interest in its efficacy and roll-out. We present mixed-methods data to explore PrEP awareness and acceptability amongst MSM.
Methods: Firstly, exploratory qualitative data (4 focus groups (FG)) of MSM in Scotland (n=22) were analysed thematically. Secondly, cross-sectional online surveys with MSM recruited in Scotland (n=841), Wales (n=350), Northern Ireland (n=214) and the Republic of Ireland (n=434) via Facebook and gay sociosexual networking media between November 2012 were analysed. Finally, in-depth interviews with MSM in Scotland (n=20) were consulted to further elucidate key findings. All samples included HIV-positive, negative and untested participants.
Results: FG discussions revealed polarised views on PrEP. HIV-positive men initially rejected PrEP use with their sexual partners, with negative/untested men more likely to consider PrEP. Survey data suggested that positive men (73%) were significantly more likely to have heard of PrEP before completing the survey than negative/untested men (30%, Chi2=85.9,df=1,p< 0.001). PrEP awareness was not patterned by country for positive (Chi2=1.1,df=3,p>0.05) or negative/untested men (Chi2=4.3,df=3,p>0.05). However, men who use the commercial gay scene were significantly more likely to have heard of PrEP for both positive (Chi2=9.7,df=1,p< 0.005) and negative/untested men (Chi2=18.5,df=1,p< 0.001). Overall, 45% of negative/untested men said they were likely to use PrEP in the future, although 29% said they were unlikely to. This PrEP acceptability amongst negative/untested men was neither patterned by country (F=1.49,df=6,1784,p>0.05), commercial gay scene use (F=1.26,df=6,1784,p>0.05) nor PrEP awareness (F=1.6,df=6,1701,p>0.05). Analysis of interview data found that negative/untested men interested in PrEP use were cautious about its effectiveness. Furthermore, PrEP use (in addition to or instead of condoms) would depend on the nature of sexual relationships and other, existing risk management strategies.
Conclusions: Findings demonstrate limited awareness but widespread interest in PrEP amongst negative/untested MSM, with the reverse pattern amongst positive men. Proximity to HIV reduces acceptability of PrEP, but awareness does not. PrEP education and support must incorporate online social/sociosexual media to target MSM who do not use the commercial gay scene as well as consider how existing risk management strategies will affect PrEP uptake.
Original languageEnglish
Publication statusPublished - 20 Jul 2014



  • MSM
  • PrEP
  • HIV prevention
  • sexual behaviour
  • mixed methods study

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