Do men who have sex with men underestimate their HIV risk and miss out on preventive PrEP?

Men who have sex with men (MSM) have a disproportionately high risk of acquiring HIV, and unprotected sex between men accounts for most new HIV diagnoses in the U.S. Yet this population tends to underestimate their HIV risk and not take advantage of effective options such as pre-exposure prophylaxis drug treatment to prevent HIV infection, as documented in an article published in LGBT Health.

Demetre Daskalakis, MD, MPH, Icahn School of Medicine at Mt. Sinai (New York, NY), Timothy Gallagher, New York University School of Medicine and Bellevue Hospital Center, and coauthors evaluated a group of MSM being tested for HIV to determine their HIV risk and whether they would be candidates for PrEP, based on demographic factors, sexual activity, and drug use during the previous three months. The authors also asked the men questions to assess how they perceived their own risk for HIV infection. The large discrepancy between actual risk and perception of risk among MSM is described in the article "Self-Perception of HIV Risk and Candidacy for Pre-Exposure Prophylaxis Among Men Who Have Sex with Men Testing for HIV at Commercial Sex Venues in New York City."

"For those MSM most at risk of HIV infection, adherence to a daily regimen of PrEP and use of condoms can potentially slow the forward transmission of HIV to the point that the epidemic cannot be maintained in regions where it is propelled by new infections among MSM," says Editor-in-Chief William Byne, MD, PhD, Icahn School of Medicine at Mount Sinai, New York, NY. "For this to occur, both MSM and their providers must be more knowledgeable about PrEP and assessment of HIV risk. Importantly, the U.S. Public Health Service just this month issued a clinical practice guideline on PrEP that addresses indications for use and assessment of HIV risk."