PrEP Use is Associated With Less HIV Anxiety Among MSM

Many men who have sex with men (MSM) experience anxiety related to the prospect of acquiring HIV. This anxiety can disrupt their emotional quality of life and contribute to fears which discourage HIV testing. Pre-exposure prophylaxis (PrEP) is highly effective at reducing risk of HIV infection, but uptake remains low among at-risk individuals in many settings.

A new study, published in the Journal of Acquired Immune Deficiency Syndrome, has discovered that among eligible MSM, PrEP use is associated with lower levels of HIV anxiety, a mental health benefit that could be incorporated into initiatives which aim to increase PrEP uptake.

Investigators gathered data using the Following Lives Undergoing Change (Flux) study, a national observational study of licit and illicit drug use among MSM in Australia. New items were introduced to the Flux study in 2018 to evaluate anxiety regarding HIV transmission.

Participants ranked 3 statements in relation to the applicability to their lives. The statements were: after having sex I sometimes get concerned that I might have done something risky; I sometimes worry about HIV before having sex; when I’m having sex HIV tends to come to mind.

Ranking ranged from 1 to 6, with 1 indicating least agreement and 6 representing most agreement.

The Flux study participants were recruited between 2014 and 2018 through community websites, Facebook, mobile phone applications, and gay dating networking websites. Men were eligible for participation if they were at least 16.5 years of age, identified as gay or bisexual, and/or had sex with a man within the past 12 months. All participants lived in Australia.

In total, 2878 MSM enrolled in the Flux study. Study results were restricted to those who had not tested HIV-positive and responded to the survey in 2018, which excluded 1331 respondents. This left 1547 men included in the HIV-anxiety analysis.

The mean age of the 1547 men included in the analysis was 37.1 years old. Most (90.6%) identified as gay, and 33.3% said most of their friends were gay. Most had also been tested for HIV before, with 89.1% having previously tested.

Over half (51.6%) of men who responded to the survey agreed with the item that they sometimes wondered if their sexual encounters were safe. Slightly more, 52.5%, agreed that they sometimes worried about HIV before sex. A smaller number, 25.9%, reported HIV coming to mind during sex.

Among PrEP-eligible MSM, those using PrEP were older and more likely to have gone to university than those who were not on the regimen. PrEP users were also more socially engaged with gay men, and despite reporting more sex partners they scored lower on both measures of generalized and HIV anxiety. Scoring lower on HIV anxiety was independently associated with PrEP use [Odds ratio .092, 95% confidence interval = 0.86 — 0.99; P = 0.006].

In addition to being a tool for HIV prevention and control, the study indicates PrEP use may improve MSM’s emotional wellbeing. Study authors suggested this feature of PrEP be highlighted as part of future demand creation initiatives to increase PrEP uptake.