Correspondence on ‘HIV transmission and previous PrEP awareness and use in men who have sex with men in Brighton, UK’

HIV pre- exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for people at- risk of HIV, including men who have sex with men (MSM). Studies from the USA/Australia describe MSM who had recently seroconverted had used PrEP inconsistently or had faced barriers to accessing and taking PrEP. 1 2 We aimed to assess prior PrEP awareness and access in MSM with newly diagnosed HIV between 2017 and 2020. We identified 59 MSM, including 1 transgender man, who were newly diagnosed with HIV. The median age was 42 years (IQR: 31–50), the majority were of white ethnicity (54/59, 91.5%) and most were UK born (55/59, 93.2%). Twenty- four out of 59 (41%) had a concurrent bacterial STI and 23/59 (39%) reported recreational drug use (4/59 (7%) reporting intravenous drug use). Thirty- five out of 59 (59%) had not attended our sexual health service prior to their HIV diagnosis. Of the remaining 24/59 (41%) who had attended our services, 16/59 (27%) reported prior awareness of PrEP. This suggests that potentially for 8/59 (14%), opportunities to discuss and start PrEP may have been missed. Only 1/59 (2%) MSM had used PrEP before, although inconsistently, and cited associations with stigma and change in self- perceived risk of HIV as the reasons for discontinuing PrEP. Five out of 59 (8%) were unable to access PrEP due to lack of clinical- trial spaces and barriers to self- funding. Eight out of 59 (14%) were interested in commencing PrEP but were found to have HIV at the time of PrEP discussion. had poor prior PrEP awareness. Access was poor among the MSM diagnosed with HIV