Awareness of PEP after sexual exposure (PEPSE)
Simon Collins, HIV i-Base
Shamela de Silva and colleagues reported the results of a prospective questionnaire completed by 88/100 men attending walk-in GU services and 83/100 HIV-positive men attending St Marys HIV clinic.
Awareness of PEP was 52% in the HIV-positive group compared to 19% of the people attending the GU clinic (P<0.001). A higher proportion of the HIV-positive group were MSM (72% vs 19%). Only half of MSM were aware of PEP in both groups; 56% and 53% of the HIV+ and GU groups respectively.
Risk behaviour and willingness to use PEP were also addressed in the study, and arguably produced more concerning results. 57% of HIV-positive MSM reported recent unprotected anal intercourse (UAI), with one in six reporting UAI with more than five partners, and one in five believing that this would probably have included an HIV-negative partner; PEP was not discussed in any of these situations.
19% of HIV-positive men reported having discussions about PEP, none of whom reported UAI.
Although 76% of the GU group reported that they would consider using PEP, this figure was much lower amongst those at higher risk. Of the 17% (15/88) of men in the GU clinic who reported recent UAI, only 3/15 (20%) men said they would consider PEP, even though 6/15 thought themselves at probable risk of exposure to HIV.
The study concluded that there was a striking lack of knowledge about PEP, and that many people at risk may miss the opportunity to use PEP, and that PEP should be discussed with both HIV-positive and HIV-negative or untested men, in both HIV and GU clinic settings.
It is unclear whether awareness of PEPSE is any greater amongst either HIV-positive individuals or HIV negative individuals exposed to HIV since this survey was undertaken in December 2004.
UK guidelines for PEPSE were introduced in April 2006. Additionally, Sir Liam Donaldson wrote to all heath trust executives advising that GUM clinics should include PEPSE within their services.
de Silva S, Miller R, Walsh J. Knowledge of HIV post-exposure prophylaxis in HIV-positive and HIV-negative men in an urban clinic population. Oral Abstract O26.