Prevalence and factors associated with use of prophylaxis for HIV and sexually transmitted infections among sexual health service attendees in England: findings from a cross-sectional observational study

Abstract Introduction HIV pre-exposure prophylaxis (PrEP) demonstrates the value of biomedical interventions as part of combination prevention. Some gay, bisexual and other men who have sex with men (GBMSM) use antibiotics to prevent sexually transmitted infections (STIs), primarily as post-exposure prophylaxis (PEP). We aimed to understand variations in awareness and use of HIV PrEP and STI PEP/PrEP among people attending specialist sexual health services (SHS) in England. Methods We collected data from SHS attendees aged >16 years in London and the East of England using an online questionnaire between April 2022 and December 2023, including awareness and use of HIV-PrEP and STI PEP/PrEP. We ran regression analyses: one to identify demographic factors associated with STI PEP/PrEP use among all SHS attendees, and a second to identify behavioural factors (controlling for socio-demographic factors) associated with antibiotic prophylaxis use among GBMSM. Results The study recruited 1,732 participants (50% GBMSM, 12% men who had reported sex with women only [MSW], 31% women). 74% had heard of HIV-PrEP but this varied by group (GBMSM:98%, MSW:39%, women:49%). 34% of GBMSM had heard of STI PEP/PrEP and 11% reported using it (MSW:15%/5%, women:18%/4%). 61% of STI PEP/PrEP users reported taking doxycycline, mostly to prevent chlamydia, gonorrhoea and syphilis. 80% of all participants reported being somewhat/very likely to use event-based STI PEP/PrEP, with a higher proportion of GBMSM saying they would be likely to use STI PEP/PrEP in this way. In the behavioural regression model of GBMSM, use was independently associated with reporting higher-risk sexual behaviour. Conclusion We found that a sizeable minority of GBMSM already use STI PEP/PrEP but some MSW and women also use or have an interest in antibiotic prophylaxis, suggesting potential benefits may exist for populations other than GBMSM. Communication should therefore should emphasise appropriate antibiotic use and the risks of antibiotic resistance among all populations. Key messages KWhat is already known on this topic Despite widespread availability of HIV-PrEP, heterosexual men and women with a need for HIV-PrEP are less likely to have this met than GBMSM Some GBMSM use antibiotics to prevent bacterial STI infections in the absence of guidelines on STI PEP/PrEP in England What this study adds Awareness of HIV-PrEP is low among heterosexual men and women The study shows that some heterosexual men and women are currently using or have an interest in STI PEP/PrEP How this study might affect research, practice or policy This study could inform HIV-PrEP awareness activities for people at risk of HIV It could also inform communication strategies for any future introduction of STI PEP/PrEP