Limited Knowledge and Use of HIV Post- and Pre-Exposure Prophylaxis Among Gay and Bisexual Men

BACKGROUND: Post-exposure prophylaxis (PEP) is currently recommended after certain high-risk exposures, and pre-exposure prophylaxis (PrEP) is undergoing evaluation in clinical trials. Media reports have suggested substantial levels of community PrEP use despite its unproven effectiveness. METHODS: We conducted a cross-sectional survey of 1819 HIV-uninfected gay/bisexual men in California to assess PEP and PrEP awareness and use. RESULTS: Overall, 47% reported PEP awareness and 4% ever used PEP. Men who were older than 25 years of age (odds ratio OR = 2. 2, 95% confidence interval CI: 1. 5 to 3. 1), were white (OR = 2. 2, 95% CI: 1. 6 to 3. 0), had an annual income >100, 000 (OR = 2. 0, 95% CI: 1. 2 to 3. 4), self-identified as gay/homosexual (OR = 2. 4, 95% CI: 1. 4 to 4. 3), and had unprotected anal sex (OR = 1. 8, 95% CI: 1. 3 to 2. 3) or sex under the influence of a drug (OR = 2. 0, 95% CI: 1. 5 to 2. 7) were more likely to be aware of PEP, whereas speed users (OR = 0. 6, 95% CI: 0. 4 to 0. 9) were less likely to be aware of PEP. Only 16% reported PrEP awareness, and <1% ever used PrEP. Unprotected anal sex (OR = 1. 6, 95% CI: 1. 1 to 2. 3) and sex under the influence of a drug (OR = 1. 5, 95% CI: 1. 0 to 2. 2) were associated with PrEP awareness. CONCLUSIONS: PEP awareness and use were modest and PrEP use was rare among gay/bisexual men in California. Although PrEP is not currently recommended, community education on the availability of PEP is suggested.