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Poppers and PrEP: Use of Pre-exposure Prophylaxis Among Men Who Have Sex with Men Who Use Inhaled Nitrites

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Abstract

Men who have sex with men (MSM) commonly use inhaled nitrites, or poppers, though their use is a risk factor HIV seroconversion. Pre-exposure prophylaxis, or PrEP, is effective for HIV prevention, but is not widely used, and little is known regarding PrEP use and acceptability among MSM who use inhaled nitrites. We surveyed 580 MSM in Paris, France in 2016 about popper use, sexual behaviors including condomless anal intercourse (CAI), serosorting, and sexual positioning, PrEP use, PrEP candidacy, and interest in alternate PrEP delivery modalities. We included 444 HIV negative participants for the current study. 46.2% reported popper use in the prior 3 months. Using multivariate adjusted logistic regression, we found that popper users were more likely than non-users to consider themselves candidates for PrEP [adjusted relative risk ratio (aRRR) = 2.73; 95% CI 1.54–4.83], but they were not more likely to be current (aRRR = 1.54; 95% CI 0.71–3.33) or past (aRRR = 1.37; 95% CI 0.44–4.28) PrEP users. Mediation analyses indicated that increased CAI and serosorting partly explained the relationship between popper use and PrEP candidacy. There was considerable interest in alternate proposed PrEP delivery modalities, particularly long-acting injectable PrEP [adjusted risk ratio (aRR) = 1.43; 95% CI 1.15–1.79].

Resumen

Los hombres que tienen relaciones sexuales con hombres (HSH) usan con frequencia los nitritos inhalados, tambien conocidos “poppers”, aunque su uso es un factor de riesgo para la seroconversión del virus de inmunodeficiencia humana (VIH). La profliaxis prexposición o “PrEP” es eficaz para la prevención del VIH, pero no se utiliza ampliamente, y poco se sabe en cuanto al uso y la aceptabilidad de PrEP entre los HSH que usan los nitritos inhalados. Hicimos una encuesta de 580 HSH en París, Francia en cuanto a su uso de los poppers, su comportamiento sexual (incluyendo el sexo anal sin condones [CAI, por sus siglas en inglés, condomless anal intercourse], el “serosorting” [tener sexo con personas con el mismo estatus de VIH], y el rol sexual [active o pasivo]), el uso de PrEP, su candidatura percibida para PrEP, y su interés en modalidades alternativas para la administración de PrEP. Incluimos 444 individuos HIV-negativos para este studio. 46,2% indicaron el uso de poppers durante los 3 meses antes de la encuesta. Usando la regresión logistica ajustada, descubrimos que los HSH que usaban los poppers se consideraban como candidatos para PrEP con más frecuencia que los que no usaban los poppers (índice de riesgo relativo ajustado (aRRR, por sus siglas en inglés, adjusted relative risk ratio)=2.73; 95% interval de confianza (CI, por sus siglas en inglés, confidence interval) = 1.54-4.83), pero no usaban el PrEP ahora (aRRR=1.54; 95% CI=0.71-3.33) o en el pasado (aRRR=1.37; 95% CI=0.44-4.28) con más frecuencia que los que no usaban los poppers. Análisis de mediación indicaron que niveles más altos de CAI y serosorting explicaron una parte de la relación entre el uso de poppers y la candidatura percibida para PrEP. También había interés considerable en otras modalidades para la administración de PrEP, especialmente PrEP inyectable de acción prolongada (indice de riesgo ajustado (aRR, por sus siglas en inglés, adjusted relative risk)=1.43; 95% CI=1.15-1.79).

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Funding

Dr. Dustin Duncan was funded in part by National Institutes of Health grants R01MH112406, R21MH110190, and R03DA039748 and the Centers for Disease Control and Prevention grant U01PS005122. This work was supported by Dr. Dustin Duncan’s New York University School of Medicine Start-Up Research Fund.

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Authors and Affiliations

  1. Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, New York, NY, 10016, USA

    H. Rhodes Hambrick, Su Hyun Park, Scott E. Sherman & Dustin T. Duncan

  2. Departments of Medicine and Public Health Sciences, University of Chicago School of Medicine, and Chicago Center for HIV Elimination, 5841 S. Maryland Avenue, MC 5065 Room L-330, Chicago, IL, 60637, USA

    John A. Schneider

  3. Departments of Medicine and Global Health and Population, Harvard Medical School and Harvard School of Public Health, and Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA

    Kenneth H. Mayer

  4. Department of Public Health Sciences, Univeristy of Miami, 1120 NW 14th St., Office 1005, Miami, FL, 33136, USA

    Adam W. Carrico

  5. Department of Population Health, Spatial Epidemiology Lab, New York University School of Medicine, 227 East 30th Street, 6th Floor, Cube 628A, New York, NY, 10016, USA

    H. Rhodes Hambrick

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HRH has no conflict of interest to report. SHP has no conflict of interest to report. JAS has no conflict of interest to report. KHM has no conflict of interest to report. AWC has no conflict of interest to report. SES has no conflict of interest to report. DTD has no conflict of interest to report.

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Hambrick, H.R., Park, S.H., Schneider, J.A. et al. Poppers and PrEP: Use of Pre-exposure Prophylaxis Among Men Who Have Sex with Men Who Use Inhaled Nitrites. AIDS Behav 22, 3658–3672 (2018). https://doi.org/10.1007/s10461-018-2139-9

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