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Despite PrEP being available and free of charge in France, a gap remains between the estimated number of men who have sex with men (MSM) with high-risk exposure to HIV and the number of MSM PrEP users. The objective of this study is to identify factors associated with non-intention to use PrEP among PrEP-eligible and PrEP-aware MSM in France, "non-intenders". European MSM Internet Survey (EMIS)-2017 was a cross-sectional survey conducted among MSM concerning their HIV prevention needs. Logistic regression models were used to identify factors associated with "non-intenders". Compared to PrEP users, factors associated with non-intention to use PrEP were: age (aOR[95%CI] = 3.80[2.21;6.53]); not being vaccinated against hepatitis B (2.20[1.45;3.34]); self-efficacy (1.84[1.29;2.60]); lower knowledge about on-demand PrEP (11.48[7.37;17.87]) and daily PrEP (2.58[1.27;5.25]); not having a PrEP discussion at a hospital (12.39[8.90;17.27]) or at a community service/drop-in (4.93[3.48;6.97]); living in a department with few PrEP access points (1.70[1.10;2.63]). On-demand PrEP may meet the prevention needs of "non-intenders" who have lower HIV risk perception. Increasing communication from health providers and community health workers to all MSM is needed. [ABSTRACT FROM AUTHOR]

Recent evidence shows that circumcision is associated with lower HIV prevalence among MSM. We assessed the acceptability of circumcision for preventing HIV and that of Shang Ring circumcision (SRC) among men who have sex with men (MSM) in China. 538 adult MSM were recruited from six cities in China between January and March 2019. Participants were surveyed by an online, self-administered questionnaire. The acceptability of circumcision was assessed before and after the potential protective effect of circumcision against HIV was informed, and subsequently men's willingness to undergo SRC was assessed. The level of circumcision was 16.4%. Of 450 uncircumcised MSM, their willingness to be circumcised in the following six months increased significantly from 32.2% to 55.6% after the information session. Three quarters of men who were willing to undergo circumcision accepted SRC. MSM who perceived that circumcision could maintain genital hygiene were more likely to accept circumcision after the information session, whereas those who regarded circumcision as an embarrassing surgery were disinclined to be circumcised. The low circumcision rate, along with its high acceptability in Chinese MSM, suggests a great potential benefit of circumcision intervention if proved effective. SRC might be a popular circumcision procedure in this population. [ABSTRACT FROM AUTHOR]

In Taiwan, men who have sex with men (MSM) continue to be disproportionately affected by HIV, and the main route of HIV transmission is condomless anal intercourse (CAI). This study examined the associations between psychosociobehavioral characteristics and CAI intention among MSM in Taiwan who had ever engaged in anal intercourse with men, and compared the differences across three sexual roles (receptive, versatile, and insertive) using online survey data (N = 563). For all MSM, those that were in a relationship (AOR = 2.55; 95% CI: 1.61–4.03), had three or more steady partners (AOR = 2.58; 95% CI: 1.19–5.58), did not use a condom during last anal intercourse (AOR = 6.81; 95% CI: 4.36–10.63), perceived high HIV risk (AOR = 2.13; 95% CI: 1.26–3.60), and had high sexual sensation seeking (AOR = 2.80; 95% CI: 1.82–4.30) were more likely to have high CAI intention. After stratification, the significant characteristics differed depending on sexual role, except for no condom use during last anal intercourse remaining significant in all models (AOR = 5.09–20.30; 95% CI: 2.49–66.69, depending on sexual role). Tailoring the programs for MSM of different sexual roles may improve the effectiveness of future prevention efforts. [ABSTRACT FROM AUTHOR]

This study measures the evolution in the overall level of protection against HIV by men who have sex with men (MSM) in France. Using data from the 2017 and 2019 editions of Rapport au Sexe – an online survey – we compared the use of HIV prevention tools by MSM during their most recent anal intercourse (MRAI) with a casual male partner. We developed a classification with five categories ordered according to the effectiveness of each tool method in reducing the risk of acquiring HIV: Treatment as prevention (TasP), Pre-exposure prophylaxis (PrEP), exclusive condom use, Post-exposure prophylaxis (PEP) or nothing (i.e., no tool used). The percentage of MSM who did not use any prevention tool decreased from 25.9% in 2017 to 23.5% in 2019 (aOR [95%CI] = 0.9 [0.8–0.9]). The proportion of MSM who took PrEP during the MRAI increased from 5.4% in 2017 to 14.0% in 2019 (aOR [95%CI] = 2.9[2.5–3.3]). The proportion of MSM who used condoms exclusively decreased from 67.5% in 2017 to 61.3% in 2019 (aOR [95%CI] = 0.8 [0.7–0.8]). We observed an increase in the rate of protected anal sex, and a decrease in the rate of condom use. The implementation of PrEP may be one of the main driving forces behind these changes. [ABSTRACT FROM AUTHOR]

Gay, bisexual and other men who have sex with men (GBMSM) experience greater health disparities, and concern about other health conditions may decrease engagement in HIV prevention. This study assessed perceived threat and impact of HIV relative to other health concerns among GBMSM. Data were from a national online survey of GBMSM conducted between August and September 2015. Participants ranked concern about contracting HIV and impact of HIV on their health compared with other health conditions. The association of HIV threat and impact with recent condomless anal sex (CAS) and HIV testing were assessed using regression models. Among 466 participants, threat and impact of HIV were ranked lower compared to cancer, Alzheimer's and heart disease. Concern about getting HIV was associated with greater odds of recent HIV testing (adjOR 1.1, 95%CI 1.02–1.18) and lower CAS (adjOR 0.86, 95%CI 0.78–0.94). Among GBMSM, other health conditions may be perceived as a greater threat and higher impact on health compared with HIV. Integrating complex health care concerns with HIV prevention strategies may increase engagement in prevention. [ABSTRACT FROM AUTHOR]

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release. [ABSTRACT FROM AUTHOR]

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but many primary care physicians (PCPs) have not incorporated PrEP into practice. While PrEP may be a key strategy to reducing high HIV transmission rates in the southern US, knowledge about PrEP prescribing patterns among PCPs in this region is lacking. An online survey was sent to a large network of PCPs at an academic medical center in North Carolina in October 2015. The survey was repeated in September 2016, after an educational intervention that included on-site trainings at 14 PCP offices. Chi-square tests were used to compare PrEP prescribing patterns among providers. The initial survey was sent to 389 PCPs, with 115 (30%) responding. Of these, 78% reported seeing men who have sex with men (MSM). Only 17% had prescribed PrEP. The most frequently identified barrier was lack of knowledge (60%). When the survey was repeated after the educational initiative, 79 PCPs (20%) responded. Of these, 90% reported seeing MSM, and 35% had prescribed PrEP. PCPs who had attended a training were more likely to have prescribed PrEP (OR 4.84, CI 1.77-13.21). In conclusion, PrEP prescribing among PCPs in the southern US is low. A survey among PCPs identified lack of knowledge as a barrier to prescribing, motivating an institutional-wide educational campaign in response. Further efforts are needed to continue to raise awareness and educate PCPs in the South about PrEP. [ABSTRACT FROM AUTHOR]