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Journal of Public Health
Published in: Journal of Public Health 9/2023

Open Access 04-03-2022 | Human Immunodeficiency Virus | Original Article

Analysis of HIV pre-exposure prophylaxis (PrEP) needs and PrEP use in Germany among men who have sex with men

Authors: Ulrich Marcus, Daniel Schmidt, Susanne B. Schink, Uwe Koppe

Published in: Journal of Public Health | Issue 9/2023

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Abstract

Aims

We aim to estimate the number of HIV pre-exposure prophylaxis (PrEP) users among men having sex with men (MSM) in Germany from 2017 through 2020, and analyse if PrEP needs expressed in 2017 might have been met by the expansion of PrEP until 2020.

Subject and methods

We estimated the number of PrEP users by using drug prescription data and information on on-demand/intermittent PrEP use from online surveys to determine the proportion of on-demand/intermittent and daily PrEP use as well as the average number of PrEP pills used.
The number of MSM in need of PrEP in 2017 was estimated based on four groups defined among respondents to a large online survey, combining respondents with PrEP use intention and respondents indicating substantial sexual risks. The size of each group was estimated based on self-selection biases. MSM with PrEP need in 2017 were compared with the estimated number of persons taking PrEP by June 2020.

Results

We estimated a total of 15,600 to 21,600 PrEP users in Germany by the end of June 2020, corresponding to 40–55% of men with PrEP use intention in 2017. A correlation between the regional distribution of PrEP use intention in 11/2017 and actual PrEP use by 06/2020 suggested an unequal regional distribution of unsatisfied needs. The number of men with unmet PrEP needs ranged between 27,500 and 93,000 in 06/2020.

Conclusion

PrEP use in Germany has increased considerably between 10/2017 and 06/2020, but large regional inequalities persist. PrEP is not yet readily accessible, and there is a need to expand services and encourage uptake.
Appendix
Available only for authorised users
Footnotes
1
(a): HIV/STI checkpoints 2019–2020 (N = 30,097): PrEP on demand (n = 835) 96% MSM, 4% non-binary, Trans*; Daily PrEP (n = 2958) 97% MSM, 2.3% non-binary, Trans*.
(b): PrEP Evaluation Project 2019-2020 (EvE-PrEP, N = 4620): PrEP on demand (n = 874) 98% MSM; Daily PrEP (n = 3737) 99% MSM
 
2
Online survey among people living with HIV in Germany in 2020 (https://​www.​idz-jena.​de/​forschung/​positive-stimmen-20/​)
 
Literature
an der Heiden M, Marcus U, Kollan C, Schmidt D, Gunsenheimer-Bartmeyer B, and Bremer V (2019) 'Schätzung der Zahl der HIV-Neuinfektionen und der Gesamtzahl von Menschen mit HIV in Deutschland, Stand Ende 2018. Epidemiologisches Bull 46:483–492
Annequin M, Villes V, Delabre RM, Alain T, Morel S, Michels D, Schmidt AJ, Velter A, Rojas Castro D (2020) Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017). AIDS Care 32:47–56CrossRefPubMed
Federal Law Gazette (BGBl) (2019) Medicinal Products Act in the version published on 12 December 2005 (Federal Law Gazette [BGBl.]) Part I p. 3394, last amended by Article 11 of the Act of 6 May 2019 (Federal Law Gazette I p. 646)
Haversath J, Gärttner KM, Kliem S, Vasterling I, Strauss B, Kröger C (2017) Sexual behavior in Germany. Dtsch Arztebl Int 114:545–550PubMedPubMedCentral
Hayes R, Schmidt AJ, Pharris A, Azad Y, Brown AE, Weatherburn P, Hickson F, Delpech V, Noori T (2019) Estimating the 'PrEP Gap: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019. Euro Surveill 24(41):1900598
Koppe U, Marcus U, Albrecht S, Jansen K, Jessen H, Gunsenheimer-Bartmeyer B, Bremer V (2019) Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study. J Int AIDS Soc 22:e25395CrossRefPubMedPubMedCentral
Marcus U, Schmidt AJ, 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 9:181CrossRefPubMedPubMedCentral
Marcus U, Gassowski M, Drewes J (2016) HIV risk perception and testing behaviours among men having sex with men (MSM) reporting potential transmission risks in the previous 12 months from a large online sample of MSM living in Germany. BMC Public Health 16:1111CrossRefPubMed
Mayer KH, Agwu A, Malebranche D (2020) Barriers to the wider use of pre-exposure prophylaxis in the United States: a narrative review. Adv Ther 37:1778–1811CrossRefPubMedPubMedCentral
Mercer CH, Prah P, Field N, Tanton C, Macdowall W, Clifton S, Hughes G, Nardone A, Wellings K, Johnson AM, Sonnenberg P (2016) The health and well-being of men who have sex with men (MSM) in Britain: evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMC Public Health 16:525CrossRefPubMedPubMedCentral
Schmidt D, Kollan C, Stoll M, Stellbrink H-J, Plettenberg A, Fätkenheuer G, Bergmann F, Bogner JR, van Lunzen J, Rockstroh J, Esser S, Jensen B-EO, Horst H-A, Fritzsche C, Kühne A, an der Heiden M, Hamouda O, Bartmeyer B, ClinSurv Study G (2015) From pills to patients: an evaluation of data sources to determine the number of people living with HIV who are receiving antiretroviral therapy in Germany. BMC Public Health 15:252CrossRefPubMedPubMedCentral
Scholz SM, Damm O, Elkenkamp S, Marcus U, Greiner W, Schmidt AJ (2019) Population size and self-reported characteristics and sexual preferences of men-who-have-sex-with-men (MSM) in Germany based on social network data. PLoS One 14:e0212175CrossRefPubMedPubMedCentral
Weatherburn P, Hickson F, Reid DS, Marcus U, Schmidt AJ (2019) European men-who-have-sex-with-men internet survey (EMIS-2017): design and methods. Sex Res Social Policy 17:543–557
Metadata
Title
Analysis of HIV pre-exposure prophylaxis (PrEP) needs and PrEP use in Germany among men who have sex with men
Authors
Ulrich Marcus
Daniel Schmidt
Susanne B. Schink
Uwe Koppe
Publication date
04-03-2022
Publisher
Springer Berlin Heidelberg
Published in
Journal of Public Health / Issue 9/2023
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI
https://doi.org/10.1007/s10389-022-01699-y

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