Wang, H.; Shobowale, O.; den Daas, C.; Op de Coul, E.; Bakker, B.; Radyowijati, A.; Vermey, K.; van Bijnen, A.; Zuilhof, W.; Jonas, K.J. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. Int. J. Environ. Res. Public Health2022, 19, 8829.
Wang, H.; Shobowale, O.; den Daas, C.; Op de Coul, E.; Bakker, B.; Radyowijati, A.; Vermey, K.; van Bijnen, A.; Zuilhof, W.; Jonas, K.J. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. Int. J. Environ. Res. Public Health 2022, 19, 8829.
Wang, H.; Shobowale, O.; den Daas, C.; Op de Coul, E.; Bakker, B.; Radyowijati, A.; Vermey, K.; van Bijnen, A.; Zuilhof, W.; Jonas, K.J. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. Int. J. Environ. Res. Public Health2022, 19, 8829.
Wang, H.; Shobowale, O.; den Daas, C.; Op de Coul, E.; Bakker, B.; Radyowijati, A.; Vermey, K.; van Bijnen, A.; Zuilhof, W.; Jonas, K.J. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. Int. J. Environ. Res. Public Health 2022, 19, 8829.
Abstract
PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called “Randstad”, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with psycho-social determinants of PrEP uptake. This cross-sectional study included 3,232 HIV-negative Dutch MSM recruited via the EMIS survey in late 2017. Prevalence and standardized prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multilevel logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, sociodemographic, psycho-social determinants, and random effects from regional differences. MSM from the Randstad used more PrEP (SPR=1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (OR=4.5, 95%CI 2.0-10.1), while there was limited influence from the awareness of PrEP (OR=0.4, 95%CI 0.04-4.4). Lower education (OR=0.4, 95%CI 0.2-0.9) was negatively associated with PrEP uptake, however, no significant difference was found between middle and high education (OR=1.2, 95%CI 0.7-2.0). We showed that regional differences – MSM in non-urban regions – and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.
Keywords
MSM; PrEP uptake; socio-spatial analysis; HIV prevention
Subject
Social Sciences, Sociology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.