HIV pre-exposure prophylaxis (PrEP) knowledge, attitudes and perceptions of sexual health risk in an age of STI antimicrobial resistance.

Ava Lorenc, Jane E Nicholls, Joanna Kesten, Louis W Macgregor, Nathan Speare, Lindsey C Harryman, Katherine Mary Elizabeth Turner, Paddy J Horner, Jeremy P Horwood*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


HIV pre-exposure prophylaxis (PrEP) has helped reduce new HIV infections. However bacterial sexually transmitted infections (STIs) have increased amongst PrEP users. We examined PrEP knowledge, access and risk perceptions in an age of antimicrobial resistance (AMR).

An online anonymous survey was distributed to all cisgender men/trans-persons-who-have-sex-with-men (MSM/TPSM) attending a sexual health clinic in Bristol, UK (October 2018 - November 2019). Interviews with a sample identified at increased risk of HIV were analysed thematically and integrated with survey data.

Five hundred and seventy-eight (95%) of 617 MSM/TPSM survey respondents were HIV-negative/unknown, of these 202 (34.9%) had ever used PrEP. Interviewees (n=24) reported widespread awareness of and enthusiasm for PrEP. Among non-users, 39% (146/376) were unaware how to access PrEP and 27% (103/376) could not access PrEP through the national ‘Impact’ trial of whom 79% (81/103) were eligible. PrEP was described as ‘life-changing’, but expense was the main barrier to use. Sixty-two percent (358/578) of HIV-negative/unknown respondents on PrEP were more likely to have condomless anal intercourse (CAI) with someone they thought was HIV-negative. Interviewees used PrEP with other risk-reduction strategies. STIs were seen as ‘curable’ and antimicrobial resistance (AMR) rarely influenced risk perception or sexual decision-making.

PrEP awareness was high, but purchase cost limited access. PrEP may increase CAI, but interviewees used PrEP as one of many risk-reduction tools. Reduced fear of HIV transmission and testing was highly valued. STI AMR was not seen as an immediate threat and did not influence risk perception or sexual decision-making.
Original languageEnglish
JournalSexually Transmitted Diseases
Publication statusAccepted/In press - 14 Jan 2021


  • Sexual Health
  • HIV
  • Sexual and Gender Minorities
  • Pre-Exposure Prophylaxis
  • Drug Resistance
  • Microbial
  • Sexually transmitted infections

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