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Awareness of, Willingness to Take PrEP and Its Actual Use Among Belgian MSM at High Risk of HIV Infection: Secondary Analysis of the Belgian European MSM Internet Survey

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Abstract

We examined PrEP awareness, willingness to take it and early PrEP use among men who have sex with men (MSM) at increased risk of HIV acquisition in Belgium. This analysis of the Belgian EMIS online data of 2017–2018 adopts a cascade approach, with the following steps quantified as conditional probabilities: being eligible for, aware of, willing to take PrEP, and PrEP use. One out of three MSM was eligible to use PrEP according to the operationalized Belgian reimbursement criteria. PrEP awareness was lower among socioeconomically vulnerable MSM, MSM living outside large cities, MSM who were less open about their sexuality and those who did not identify as gay or homosexual. A lack of PrEP knowledge, a higher self-efficacy regarding safe sex, having a steady partner and reporting more symptoms of depression were related to unwillingness to use PrEP. Among those willing to take PrEP, less than one third were actually using PrEP. Not using PrEP was associated with living in small cities and experiencing financial problems.

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Data Availability

Individuals and organisations are welcome to use individual questions, question sets or whole EMIS-2017 questionnaires, on the understanding that they give due credit: Sigma Research @ London School of Hygiene & Tropical Medicine developed the EMIS-2017 questionnaire within the framework of the ESTICOM project funded by the EU Health Programme 2014–2020 under service contract 2015-71-01.

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Acknowledgements

We begin by thanking all of the men who took part in EMIS 2017 and the Belgian NGO partners. We also thank all the partners involved—Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). BEL: Sensoa, Ex Aequo, Observatoire du SIDA et des sexualités, Sciensano.

Funding

This study is part of the Promise project ‘Optimise PrEP to Maximise Impact’, funded by FWO-SBO (Flemish Scientific Research – Strategic Basic Research). The data used stem from the EMIS project. EMIS-2017 was carried out as part of ESTICOM, under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. EMIS-2017 was carried out under the service contract 2015 71 01. Funding was provided by FWO-SBO (Grant No. 58619).

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Authors and Affiliations

  1. Department of Sociology, University of Antwerp, Stadscampus – S.Z.210, Kipdorp 61, 2nd Floor -2000, Antwerp, Belgium

    Veerle Buffel, Caroline Masquillier, Estrelle Thunissen & Edwin Wouters

  2. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

    Thijs Reyniers, Christiana Nöstlinger, Marie Laga & Bea Vuylsteke

  3. Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium

    Wim Vanden Berghe & Jessika Deblonde

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  1. Veerle Buffel
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  2. Thijs Reyniers
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  3. Caroline Masquillier
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  10. Bea Vuylsteke
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Contributions

Study concept and design: VB, TR, BV, CM, ET, EW, WVB, and JD. Analysis and interpretation of data: VB and TR. Drafting of the manuscript: VB and TR. Critical revision of the manuscript for important intellectual content: TR, CM, EW, CN, BV, ML, WVB and JD. Study supervision: EW and BV. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Veerle Buffel.

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No potential conflict of interest was reported by the author(s).

Ethics Approval

Ethics approval was granted for the EMIS project by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine (reference 14421/RR/8805) on 31 July 2017.

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Appendices

Appendix

Appendix 1: Eligibility criteria for PrEP reimbursement in Belgium (issued by the National institute for Health and Disability Insurance as of June 1, 2017) and detailed information about its operationalization using the EMIS data

 

Belgian eligibility criteria

Available variables in the EMIS data relevant for the eligibility criteria

Operationalized eligibility criteria

Percentage MSM meeting this criteria

I. Specific criteria targeting MSM (men who have sex with men)

%

(N/N total excl. missings)

1

who have had unprotected anal sex with at least 2 partners in the last 6 months

• How many non-steady male partners have you had intercourse without a condom within the last 12 months? (number)

(no information about the last six months)

• When did you last have intercourse with a man (either with or without a condom)?

Having intercourse without condom with at least two different non-steady male partners during the last 12 months (and having intercourse the last 6 months)

16,1% (371/2300)

2

who have had multiple Sexually Transmitted Infections (STIs) (Syphilis, Chlamydia, Gonococcus or a primary infection with hepatitis B or C) during the last 12 months

• When were you last diagnosed with syphilis? gonorrhoea? Chlamydia or LGV?

• When were you first diagnosed with hepatitis C?

(no information about the number of infections per type of STI)

Diagnosed with at least 1 STI (syphilis, gonorrhoea, chlamydia or LGV, or a primary infection with hepatitis C) last 12 months

3,4% (82/2396)

3

who needed Post exposure Prophylaxis (PEP) more than once during the last 12 months

• Have you ever taken PEP?

- No, I could not get it

- No, I had the opportunity but decided not to take it

- Yes, I’ve taken one course of pills

- Yes, I’ve taken more than one course of pills

(no information about when PeP was taken)

Taken more than one course of PEP pills

2%

(48/2396)

4

who use psychoactive substances during sexual activities

• When was the last time you used stimulant drugs to make sex more intense or last longer?

(The stimulant drugs include ecstasy or MDMA, cocaine, amphetamine (speed), crystal methamphetamine (Tina, Pervitin), mephedrone and ketamine.)

Taken stimulant drugs during sex to make it more intense or last longer in the last 12 months

14,3%

(338/2366)

II. General criteria for people at high-risk of HIV acquisition

 

5

People who inject drugs (PWID) who share needles

• When was the last time you injected with a used needle or syringe given, lent, rented or sold to you by someone else?

Injected drugs with a used needle last 12 months

0,7% (17/2371)

6

People in sex work who are exposed to unprotected sex

• When was the last time you were paid by a man to have sex with him. By paid we mean he gave you money, gifts or favours in return for sex?

Being paid to have sex in the last 12 months

4,5%

(105/2348)

7

People in general who are exposed to unprotected sex with a high risk of HIV infection

Not applicable

(MSM with a high risk of HIV infection are already identified by the other criteria)

 

8

Partners of people living with HIV (PLWH) without viral suppression (recently started on treatment or no viral suppression with adequate treatment)

• In the last 12 months, have you had intercourse without a condom with a non-steady partner who you knew at the time was HIV positive?

• Did that HIV-positive man or those HIV-positive men have undetectable viral load?

• Does your steady male partner have HIV? (If you have more than one steady relationship with a man, please tell us about the longest)

- No, he is HIV negative

- Yes, and he has an undetectable viral load

- Yes, and his viral load is detectable

- Yes, and I do not know what his viral load is –

- I don’t know whether he has HIV or not

Having condomless intercourse with (a) HIV positive partner(s), without knowing whether he (they) have undetectable viral load or knowing he (they) did not have

2,5%

(59/2396)

Total

At least one of the criteria

  

33,2%

(795/2396)

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Buffel, V., Reyniers, T., Masquillier, C. et al. Awareness of, Willingness to Take PrEP and Its Actual Use Among Belgian MSM at High Risk of HIV Infection: Secondary Analysis of the Belgian European MSM Internet Survey. AIDS Behav 26, 1793–1807 (2022). https://doi.org/10.1007/s10461-021-03526-z

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