Disclosure of speaker’s interests No conflict of interest

Informal PrEP use among MSM in Europe – first results from the EU Flash PrEP survey Kai J. Jonas Maastricht University Sascha Duken University of Amsterdam Richard Stranz, Adeline Bernier, Vincent Schlegel AIDES, Paris, France

Informal PrEP use in Europe Denmark 6 UK 65 France 19 Germany 149 Greece 4 Netherlands 16 Italy 1 Portugal 3 Romania 0 Spain 6 Switzerland 9 Ireland 13 Other 21 EU Flash PrEP Survey, conducted Summer 2016 in 12 European countries N= 15.880 N=312 informal PrEP users, 1.96% of total population Mean age 39, range 18-66 Gender 303 male 5 transgender 4 female

Types of use: Daily, intermittent and recreational Duration N (%) I’m no longer using it 116 (37.5) Less than 3 months 65 (21) 3-6 months 59 (19.1) 7-12 months 40 (12.9) More than a year 29 (9.4) Regimen N (%) Daily 155 (50.8) Intermittent/on-demand 129 (42.3) Other 21 (6.9) Intermittent Regimen N (%) Every time you have sex 38 (26.8) Just when you think it is risky 104 (73.2) Intermittent regimen N (%) Several times a week 19 (13.3) Once or twice a week 10 (7) Less than once a week 22 (15.4) Once a month 21 (14.7) Less than once a month 71 (49.7) Type of medication N (multiple answers possible) Truvada ® 192 Generic Truvada ® 113 Other 24

Adherence Missing a dose Yes / No Daily 59 / 96 Intermittent/on-demand 75 / 53 Other 9 / 10 More individuals on an intermittent scheme of PrEP use miss a dose Main reasons for missing a dose were: Forgetting Running out of tablets No more sex Not being able to obtain it anymore

Sourcing of PrEP Main sources of PrEP were: Doctor‘s prescription (own payment) Via PEP Via HIV positive friends Online purchase Purchase generics in other countries Costs of PrEP were: 0€ for 29.7% of the informal users Mean = 113€ (SD = 280, range 0.1 – 2000)

Medical Check-ups Creatine use and informal PrEP use: 17.7% Prior (kidney/liver) N (%) Yes 150 (48.1) No 162 (51.9) During use overall N (%) Daily Interm. Once before start 27 (18.2) 16 (16.2) 9 (25) Every three months 96 (64.9) 71 (71.7) 16 (44.4) Irregularly 25 (16.9) 12 (12.1) 11 (30.6) Creatine use and informal PrEP use: 17.7% HIV testing A lot lower than before N (%) Lower than before The same Higher than before A lot higher than before Daily 2 (1.3) 4 (2.6) 69 (45.4) 51 (33.6) 26 (17.1) Intermittent 2 (1.4) 3 (2.1) 90 (63.4) 39 (27.5) 8 (5.6)

Medical Check-ups: HIV testing Past HIV testing Past 12 months N More than a year ago Never Daily 148 7 Intermittent 141 6 3 HIV test frequency/ 12 month 1 N 2 3 4 5+ Daily 8 30 40 35 Intermittent 23 37 29 32 18

Condom use and HIV risk assessment A lot lower than before N (%) Lower than before The same Higher than before A lot higher than before Daily 44 (28.9) 42 (27.6) 56 (36.8) 4 (2.6) 6 (3.9) Intermittent 34 (23.8) 42 (29.4) 67 (46.9) HIV risk assessment A lot lower than before N (%) Lower than before The same Higher than before A lot higher than before Daily 83 (55.7) 38 (25.5) 22 (14.8) 3 (2.0) Intermittent 53 (36.8) 47 (32.6) 37 (25.7) 7 (4.9)

Informal use intention Intention to start PrEP use (excl. Romania) No, definitely not N (%) No, probably not Maybe Yes, probably Yes, definitely When it becomes officially available 1281 (9.0) 2153 (15.2) 3712 (26.1) 3904 (27.5) 2885 (20.3) Before it becomes officially available 4878 (34.3) 4345 (33.6) 2606 (18.9) 1136 (8.2) 550 (3.9) „Yes probably“ and „Yes definitely“ percentages do not differ by country for informal use, but do differ for formal use intentions.

Questions and feedback: Thanks a lot! Questions and feedback: kai.jonas@maastrichtuniversity.nl