Brief Report: Gaps in HIV Preexposure Prophylaxis Acceptance: Findings From an Outpatient HIV Testing Service in Italy

Background: The aim of this study is to assess the acceptability of HIV preexposure prophylaxis (PrEP) among individuals eligible for prophylaxis.

Setting: Retrospective study of individuals receiving their first HIV test at the Infectious Diseases Unit of IRCCS San Raffaele Scientific Institute, Milan, Italy.

Methods: People (1) who received their first HIV test (baseline date) between January 2018 (availability of PrEP in Italy) and December 2023 (data lock) and (2) with an indication for PrEP based on condomless sex were included; those already on PrEP were excluded. Individuals with a negative HIV test result were offered PrEP counseling and prescription according to guidelines. Characteristics of people who accepted or declined HIV PrEP were compared using Mann-Whitney or χ 2 tests, as appropriate.

Results: A total of 2627 people were tested for HIV: 175 (6.6%) were diagnosed with HIV. Of the 2452 people with negative HIV test results, 2165 (88.3%) were men; median age was 34.3 years (interquartile range = 28.7-42.4). Sexually transmitted infections were detected in 478 of 2452 (19.5%) people, most commonly gonorrhea (206/2452, 8.4%). Overall, 982 of 2452 (40.0%) people accepted PrEP, including only 3 women. Nonacceptance was higher among women ( P < 0.001) and non-White ( P < 0.001). Of those who did not accept PrEP, 260 (17.7%) were diagnosed with at least 1 sexually transmitted infection at the time of HIV testing.

Conclusions: Low PrEP acceptance was observed, particularly among women and people of non-White origin. Nonacceptance of PrEP was also observed among individuals diagnosed with an sexually transmitted infection.