New HIV diagnoses are rising in Turkiye. Men who have sex with men (MSM) are estimated to be the main driver of the epidemic. Pre-exposure prophylaxis (PrEP) was proven to be effective in reducing new HIV diagnoses and PrEP recently became available in Turkiye.
Objective
To assess awareness of and willingness to use PrEP and the level of off-licence use among MSM.
Methods
An anonymous self-completed questionnaire was sent out over the Hornet Gay Social Network from December 2019 to February 2020, available in Turkish and Arabic. It included 20 questions on HIV and STI testing, PrEP awareness, PrEP use, willingness to use, chemsex and sexual happiness level.
Results
Overall 4761 respondents who responded to more than 1/3 of the questions were eligible for analyses; 5.5% was Arabic speaking. The mean age was 30.5 years, 31.4% had never tested for HIV, 40.5% knew what PrEP was, the most common source of knowledge was the internet (44.5%), 2.5% (120) had used PrEP in the last 12 months and 1.7% (83) was current users. PrEP users had accessed drugs over the internet (47.6%), pharmacy (23%), and friends (13.8%). Almost 40% were willing to use PrEP in the following 6 months. Younger and Arabic speaking respondents had lower rates of HIV testing (p = .001) and lower awareness for PrEP than comparators (p = .004).
Conclusion
Awareness and willingness to use PrEP is high among MSM in Turkiye. The recent availability of PrEP in the country is a big step forward in terms of prevention.
YaylaliEGokenginDKortenV, et al.Modelling the future of HIV in Turkiye: disease implications of improving prevention, diagnosis and treatment. Poster abstract, P114. HIV glasgow virtual 5-8 October 2020. J Int AIDS Soc2020; 23(7): 96–97. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.25616
KoksalMOBekaHEvliceO, et al.Syphilis seroprevalence among HIV-infected males in Istanbul, Turkiye. Rev Argent Microbiol2020; 52(4): 266–271.
9.
SarigulFSayanMInanD, et al.Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health2019; 27(3): 223–228.
10.
SenogluSYesilbagZKaraosmanogluHK, et al.Epidemiological differences and risk factors for hospitalization in people living with HIV in Istanbul, Turkiye. Int J STD AIDS2019; 30(13): 1284–1289.
11.
GokenginDAybekGAralSO, et al.Programmatic mapping and size estimation of female sex workers, transgender sex workers and men who have sex with men in İstanbul and Ankara, Turkiye. Sex Transm Infect2021; 97: 590–595.
12.
BavintonBRGrulichAE. HIV pre-exposure prophylaxis: scaling up for impact now and in the future. Lancet Public Health2021; 6(7): e528–e533.
13.
ChouREvansCHovermanA, et al.Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the US Preventive Services Task Force. JAMA2019; 321: 2214–2302.
14.
RutsteinSESmithDKDalalS, et al.Initiation, discontinuation, and restarting HIV pre-exposure prophylaxis: ongoing implementation strategies. Lancet HIV2020; 7: e721.
15.
KowalskaJDBursaDGokenginD, et al.HIV health care providers are ready to introduce pre-exposure prophylaxis in central and eastern Europe and neighbouring countries: data from the euroguidelines in central and eastern Europe (ECEE) network group. HIV Med2018; 19(9): 629–633.
16.
BalayanTBegovacJSkrzat-KlapaczyńskaA, et al.Where are we with pre-exposure prophylaxis use in central and eastern Europe? Data from the euroguidelines in central and eastern Europe (ECEE) network group. HIV Med2021; 22(1): 67–72.
GrulichAEJinFVaccherS, et al.Continuing low HIV incidence in the expanded pre-exposure prophylaxis (PrEP) Implementation in Communities—New South Wales study (EPIC-NSW). 10th International AIDS Society Conference on HIV Science; Mexico CityOral abstract, TUAC0201. J Int AIDS Soc2019; 22(S5): e25327. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.25327
19.
BuchbinderSPHavlirDV. Getting to zero San Francisco: a collective impact approach. J Acquir Immune Defic Syndr2019; 82(3): 176–182.
20.
BourneAAlbaBGarnerA, et al.Use of, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and central Asia: findings from a 2017 large geosocial networking application survey sex transm. Infect2019; 95: 187–192.
21.
SegalK. The evolution of oral PrEP access: tracking trends in global oral PrEP use over time. HIV research for prevention congress (HIV R4P; virtual); Jan 28, 2021.Oral abstract OA11.01. J Int AIDS Soc2021; 24(S1): 27.
KowalskaJDBursaDGokenginD, et al.HIV health care providers are ready to introduce pre-exposure prophylaxis in central and eastern Europe and neighbouring countries: data from the euroguidelines in central and eastern Europe (ECEE) network group. HIV Med2018; 19(9): 629–633.
24.
HayesRSchmidtAJPharrisA, et al.Estimating the ‘PrEP Gap’: how implementation and access to PrEP differ between countries in Europe and central Asia in 2019. Euro Surveill2019; 24(41): pii=1900598.
25.
TorresTSDe BoniRBde VasconcellosMT, et al.Awareness of prevention strategies and willingness to use preexposure prophylaxis in Brazilian men who have sex with men using apps for sexual encounters: online cross-sectional study. JMIR Public Health Surveill2018; 4(1): e11.
26.
AnnequinMVillesVDelabreRM, et al.Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017). AIDS Care2020; 32(sup2): 47–56.
27.
GokenginDBursaDSkrzat-KlapaczynskaA, et al.PrEP scale-up and PEP in Central and Eastern Europe: what has changed and what challenges we face? In: 32nd European congress of clinical microbiology and infectious diseases. 2022. Lisbon, Portugal: Oral presentation, pp. 03392.
28.
Kumbasar-KaraosmanogluHMeteBGündüzA, et al.Late presentation among patients with human immunodeficiency virus infection in Turkiye. Cent Eur J Public Health2019; 27(3): 229–234.
29.
SarginFSafakG. HIV prevalence among men who have sex with men in Istanbul. Int J Infect Dis2017; 54: 58–61.
30.
GokenginDAybekGEmmanuelF, et al.HIV prevalence in high risk populations in Istanbul; preliminary results (in Turkish). In: National HIV/AIDS Congress. Antalya, Turkiye: Poster abstract. 2017.
31.
LandovitzRJTsengCHWeissmanM, et al.Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California. J Urban Health2013; 90(4): 729–739.
32.
LehmillerJJIoergerM. Social networking smartphone applications and sexual health outcomes among men who have sex with men. PloS One2014; 9(1): e86603.
33.
RendinaHJJimenezRHGrovC, et al.Patterns of lifetime and recent HIV testing among men who have sex with men in New York city who use grindr. AIDS Behav2014; 18: 41–49.
34.
WinetrobeHRiceEBauermeisterJ, et al.Associations of unprotected anal intercourse with Grindr-met partners among Grindr-using young men who have sex with men in Los Angeles. AIDS Care2014; 26(10): 1303–1308.
35.
HollowayIWPulsipherCAGibbsJ, et al.Network influences on the sexual risk behaviors of gay, bisexual and other men who have sex with men using geosocial networking applications. AIDS Behav2015; 19(2): 112–122.
36.
HosekSGSiberryGBellM, et al.The acceptability and feasibility of an HIV preexposure prophylaxis (PrEP) trial with young men who have sex with men. J Acquir Immune Defic Syndr2013; 62(4): 447–456.
37.
HanumNCambianoVSewellJ, et al.Use of HIV pre-exposure prophylaxis among men who have sex with men in England: data from the AURAH2 prospective study. Lancet Public Health2020; 5: e501–e511.
38.
HollowayIDoughertyRGildnerJ, et al.PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications. J Acquir Immune Defic Syndr2017; 74(1): 15–20.
39.
KhannaASMichaelsSSkaathunB, et al.Preexposure prophylaxis awareness and use in a population-based sample of young black men who have sex with men. JAMA Intern Med2016; 176(1): 136–138.
40.
KuhnsLMHottonALSchneiderJ, et al.Use of pre-exposure prophylaxis (PrEP) in young men who have sex with men is associated with race, sexual risk behavior and peer network size. AIDS Behav2017; 21(5): 1376–1382.
41.
United Nations High Commissioner for Refugees (UNHCR). Syria regional refugee response inter-agency information sharing portal 20172022. Available from: https://www.unhcr.org/syria-emergency.html
BirdthistleIMulwaSSarrassatS, et al.Effects of a multimedia campaign on HIV self-testing and PrEP outcomes among young people in South Africa: a mixed-methods impact evaluation of 'MTV Shuga Down South. BMJ Glob Health2022; 7(4): e007641.
46.
LeeJJAguirre HerreraJCardonaJ, et al.Culturally tailored social media content to reach Latinx immigrant sexual minority men for HIV prevention: web-based feasibility study. JMIR Form Res2022; 6(3): e36446.
47.
MarshallBSalabarría-PeñaYJohnsonW, et al.Reaching racial/ethnic and sexual and gender minorities with HIV prevention information via social marketing. Eval Program Plann2022; 90: 101982.
48.
VellozaaJKapogiannisBBekkerLG, et al.Interventions to improve daily medication use among adolescents and young adults: what can we learn for youth pre-exposure prophylaxis services?AIDS2021; 35: 463–475.
49.
FieldsELongADangerfieldDT, et al.There’s an app for that: using geosocial networking apps to access young black gay, bisexual, and other MSM at risk for HIV. Am J Health Promotion2020; 34(1): 42–51.
50.
HoornenborgEPrinsMAchterberghRCA, et al.Acquisition of wild-type HIV-1 infection in a patient on pre-exposure prophylaxis with high intracellular concentrations of tenofovir diphosphate: a case report. Lancet HIV2017; 4: e522–e528.
51.
VolkJENguyenDPHareCB, et al.HIV infection and drug resistance with unsupervised use of HIV pre-exposure prophylaxis. AIDS Res Hum Retroviruses2018; 34(4): 329–330.
52.
LarocheHLionsCZaegel-FaucherO, et al.Unsupervised PrEP in routine practice: a new challenge?Int J STD AIDS2019; 30(7): 715–717.
53.
KoppeUSeifriedJMarcusU, et al.HIV, STI and renal function testing frequency and STI history among current users of self-funded HIV pre-exposure prophylaxis, a cross-sectional study, Germany, 2018 and 2019. Euro Surveill2022; 27(14): 2100503.
54.
PsomasCKPenarandaGRetornazF, et al.A cohort analysis of sexually transmitted infections among different groups of men who have sex with men in the early era of HIV pre-exposure prophylaxis in France. J Virus Erad2022; 8(1): 100065.
55.
StreeckHJansenKCrowellTA, et al.HIV pre-exposure prophylaxis was associated with no impact on sexually transmitted infection prevalence in a high-prevalence population of predominantly men who have sex with men, Germany, 2018 to 2019. Euro Surveill2022; 27(14): 2100591.
56.
BristowCCHassanAMooreDJ, et al.Sexually transmitted infections among participants in an HIV PrEP adherence trial. Int J STD AIDS2022; 33(4): 397–403.
57.
GiromettiNMcCormackSTittleV, et al.Rising rates of recent preexposure prophylaxis exposure among men having sex with men newly diagnosed with HIV: antiviral resistance patterns.
