HIV Pre-Exposure Prophylaxis (PrEP) Is Coming to Europe, but Are Gay Men Ready to Accept It? Qualitative Findings from Berlin, Germany
In 2016, the European Medicines Agency approved the marketing of Truvada for use as pre-exposure prophylaxis (PrEP) in European Union (EU) member states. As individual countries throughout the EU make decisions about whether to adopt PrEP and fund it via governmental insurance, it is vital to understand key populations’ knowledge of and attitudes toward PrEP. In 2015, 20 gay men completed face-to-face audio-recorded interviews, describing their knowledge of and attitudes toward PrEP (mean age 35.9; 35% HIV-positive, 65% HIV-negative). We found that in spite of PrEP not yet having been approved for marketing in Germany, all but one of the participants were aware of PrEP and knew the difference between PrEP and post-exposure prophylaxis (PEP; which is approved for use in Germany). By and large, attitudes were favorable about PrEP, especially among HIV-negative participants. Next, there appeared to be an already high demand for PrEP with several participants going to great lengths to gain access to PrEP; two described intentions to obtain PEP for use as PrEP, one was obtaining PrEP via another country (where it was legal), and a fourth participant was discretely distributing PrEP out of his home. Our findings appear to validate anecdotal evidence suggesting high demand for PrEP and that some are already finding ways to obtain it without governmental approval. Our findings suggest that participants were prepared to see the rollout of PrEP in Berlin, pending its approval.
KeywordsPre-exposure prophylaxis (PrEP) Gay men Men who have sex with men Barebacking HIV Berlin Germany
This study was supported in part by the Tow Fellowship. A special thanks to the research participants who gave their time and shared their stories, Philip Gussmann, and the research team at the Hunter College Center for HIV/AIDS Educational Studies and Training.
Compliance with Ethical Standards
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Research Involving Human Participants
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. Consent documents were available in English and German.
This study was supported in part by the Tow Fellowship.
- Barnett, L. (2013. Germany a “sex tourism hotspot”. Retrieved from http://www.telegraph.co.uk/news/worldnews/europe/germany/10452246/Germany-a-sex-tourism-hotspot.html.
- Beachy, R. (2015). Gay Berlin: Birthplace of a modern identity. New York: Vintage.Google Scholar
- CDC. (2014). Pre-exposure prophylaxis for the prevention of HIV infection in the United States—2014: A clinical practice guideline. Retrieved from http://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf.
- Cohen, S. E., Vittinghoff, E., Bacon, O., Doblecki-Lewis, S., Postle, B. S., Feaster, D. J., & Estrada, Y. (2015). High interest in pre-exposure prophylaxis among men who have sex with men at risk for HIV-infection: Baseline data from the US PrEP demonstration project. Journal of acquired immune deficiency syndromes (1999), 68(4), 439.CrossRefGoogle Scholar
- Edsall, N. C. (2006). Toward stonewall: Homosexuality and society in the modern western world. Charlottesville: University of Virginia Press.Google Scholar
- European Medicines Agency. (2016). European Medicines Agency—What we do—Authorization of medicines. Retrieved from http://www.ema.europa.eu/ema/index.jsp?curl=pages/about_us/general/general_content_000109.jsp.
- Gilead. (2012). U.S. Food and Drug Administration approves Gilead’s Truvada® for reducing the risk of acquiring HIV | Gilead. Retrieved from http://www.gilead.com/news/press-releases/2012/7/us-food-and-drug-administration-approves-gileads-truvada-for-reducing-the-risk-of-acquiring-hiv.
- Gilead. (2016). European Medicines Agency validates Gilead’s type II variation application for Truvada® for reducing the risk of sexually acquired HIV. Retrieved from http://www.gilead.com/news/press-releases/2016/2/european-medicines-agency-validates-gileads-type-ii-variation-application-for-truvada-for-reducing-the-risk-of-sexually-acquired-hiv.
- Golub, S. A., Gamarel, K. E., Rendina, H. J., Surace, A., & Lelutiu-Weinberger, C. L. (2013). From efficacy to effectiveness: Facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDs, 27(4), 248–254.CrossRefPubMedPubMedCentralGoogle Scholar
- Grov, C., Rendina, H. J., Whitfield, T. H. F., Ventuneac, A., & Parsons, J. T. (2016). Changes in familiarity with and willingness to take PrEP in a longitudinal study of highly sexually active gay and bisexual men. LGBT Health, 3(4), 252–257. doi: 10.1089/lgbt.2015.0123.CrossRefPubMedPubMedCentralGoogle Scholar
- Jaspal, R., & Daramilas, C. (2016). Perceptions of pre-exposure prophylaxis (PrEP) among HIV-negative and HIV-positive men who have sex with men (MSM). Cogent Medicine (just-accepted), 1256850.Google Scholar
- Kramer, S. C., Drewes, J., Kruspe, M., & Marcus, U. (2015). Factors associated with sexual risk behaviors with non-steady partners and lack of recent HIV testing among German men who have sex with men in steady relationships: Results from a cross-sectional internet survey. BMC Public Health, 15(1), 702.CrossRefPubMedPubMedCentralGoogle Scholar
- Lonely Planet. (2012. Top gay-friendly destinations. Retrieved from http://www.lonelyplanet.com/travel-tips-and-articles/76124
- Marcus, U., Schmidt, A. J., Kollan, C., & Hamouda, O. (2009). The denominator problem: Estimating MSM-specific incidence of sexually transmitted infections and prevalence of HIV using population sizes of MSM derived from Internet surveys. BMC Public Health, 9(1), 181.CrossRefPubMedPubMedCentralGoogle Scholar
- Marcus, U., Voss, L., Kollan, C., & Hamouda, O. (2006). HIV incidence increasing in MSM in Germany: Factors influencing infection dynamics. Euro surveillance: bulletin europeen sur les maladies transmissibles= European communicable disease bulletin, 11(9), 157–160.Google Scholar
- McCall, H., Adams, N., Mason, D., & Willis, J. (2015). What is chemsex and why does it matter?Google Scholar
- Miles, M. B., & Huberman, M. (1994). Qualitative data analysis: An expanded sourcebook. Thousand Oaks: Sage Publications.Google Scholar
- Morgenpost.de. (2010). Two million citizens speak at least two languages—Wirtschaft (Print)—Berliner Morgenpost. Retrieved from http://www.morgenpost.de/printarchiv/wirtschaft/article104168858/Zwei-Millionen-Berliner-sprechen-mindestens-zwei-Sprachen.html#modal
- Neuendorf, K. A. (2002). The content analysis guidebook. Thousand Oaks: Sage.Google Scholar
- Parsons, J. T., Rendina, H. J., Lassiter, J. M., Whitfield, T. H. F., Starks, T. J., & Grov, C. (2017). Uptake of HIV pre-exposure prophylaxis (PrEP) in a national sample of gay and bisexual men in the United States: The motivational PrEP cascade. Journal of AIDS.Google Scholar
- Patton, M. Q. (1990). Qualitative evaluation research (2nd ed.). Newbury Park: Sage Publications, Inc..Google Scholar
- PrEP in Europe Initiative. (2016). PrEP access in Europe. Retrieved from http://www.aidsmap.com/v636124231530170000/file/1213299/PrEP_in_Europe_Initiative_report.pdf.
- PrEPWatch. (2015). France Retrieved from http://www.prepwatch.org/france/.
- PrEPWatch. (2016). Country updates. Retrieved from http://www.prepwatch.org/scaling-up/country-updates/.
- Robert Koch Institut. (2013). Epidemiologisches Bulletin: HIV-infektionen und AIDS-Erkankungen in Deutschland. 24.Google Scholar
- Robert Koch Institut. (2014). Epidemiologisches Bulletin: Aktuelle Daten und Informationen zu Infektionskrankheiten und Public Health. Retrieved from http://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2014/Ausgaben/44_14.pdf?__blob=publicationFile.
- Rodgers, T. (2014). Berghain: The secretive, sex-fueled world of techno’s coolest club. Retrieved from http://www.rollingstone.com/music/news/berghain-the-secretive-sex-fueled-world-of-technos-coolest-club-20140206.
- Saldaña, J. (2013). The coding manual for qualitative research (2nd ed.). Thousand Oaks: Sage.Google Scholar
- Spiegel Online. (2015). Testing the limits: How many refugees can Germany handle? Retrieved from http://www.spiegel.de/international/germany/germany-being-tested-by-huge-refugee-influx-a-1045560.html.
- Tangmunkongvorakul, A., Chariyalertsak, S., Amico, K. R., Saokhieo, P., Wannalak, V., Sangangamsakun, T., et al. (2013). Facilitators and barriers to medication adherence in an HIV prevention study among men who have sex with men in the iPrEx study in Chiang Mai, Thailand. AIDS Care, 25(8), 961–967.CrossRefPubMedGoogle Scholar
- WHO. (2014). Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Retrieved from http://www.who.int/hiv/pub/guidelines/keypopulations/en/.
- WHO. (2015). WHO expands recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP): Policy brief. Retrieved from http://www.who.int/hiv/pub/prep/policy-brief-prep-2015/en/.
- Zarwell, M., Payne, N., & Robinson, W. T. (2015). Usage and perceptions of PrEP among men who have sex with men (MSM) in New Orleans, 2014. Paper presented at the 143rd APHA Annual Meeting and Exposition, Chicago.Google Scholar