OA07.03
Background: The public health benefit of PrEP will depend on effective targeting of higher risk individuals. We report the baseline sexual behaviour of men enrolled in England's PROUD pilot study.
Methods: In PROUD, eligible HIV negative gay/MSM, aged 18+, who report recent and intended condomless anal sex, are randomized to receive Truvada as PrEP immediately or after 12 months.
Results: The PROUD cohort of 470 men are a median age of 35 (IQR 34-36), 79% white, 58% UK born, 60% university educated, 82% employed, 47% in a relationship and 96% self-identify as gay. Anal sex was reported with a median of 10 (IQR 5-20) partners total, and 7 (IQR 2-15) new partners in the last 90 days. Condoms were not used with a median of 2 (IQR 1-5) partners for receptive sex and 3 (IQR 1-6) for insertive. Reasons for no condom at last condomless sex were: 66% less pleasure, 51% don't like condoms, 33% partner didn't like condoms, 27% condoms not discussed, 23% and 22% under influence of drugs or alcohol (68% consumed alcohol weekly and 73% used recreational drugs in the last 90 days). At last condomless sex, 45% assumed partner to be HIV-, 27% HIV+on ART, 23% HIV unknown, 5% HIV+not on/unknown ART. When having condomless anal sex, 29% felt at little or no risk, 47% somewhat at risk, 23% at high risk. Risk reduction strategies reported were: 39% use condoms, 26% ask partner to use condom, 38% chose HIV- partners, 29% use strategic positioning, 23% seek partners on ART; only 16% reported no strategy. In the last year 39% had used PEP (19% >= 2 times); 87% had visited a clinic>= 2 times for HIV and 82% for STI testing. 37% reported a bacterial rectal STI, which was associated with higher numbers of condomless sex partners (OR 1.09 receptive p<0.001, 1.04 insertive p=0.011).
Conclusions: PROUD is enrolling gay men who are selective condom users with high rates of STIs, who despite regular clinic attendance and use of risk reduction strategies, including sero-sorting and PEP, are likely to be at high risk of HIV acquisition.
