Ethics approval and consent to participate
EMIS-2017 received a favourable ethical opinion from the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine (review reference 14421 /RR/8805) on 31 July 2017.
The PrApp study was approved by the ethics commission of the Berlin Chamber of Physicians (Ref: Eth-14/18). All participants had to provide informed consent before starting the survey.
Consent for publication
Not applicable.
Availability of data and materials
Most data generated or analysed during this study are included in this published article and its supplementary information files.
The remaining data that support the findings of this study are available from the London School of Hygiene and Tropical Medicine but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the London School of Hygiene and Tropical Medicine.
Competing interests
UK owns ‘Exchange-traded fund’ (ETF) shares, which may include stocks of pharmaceutical companies that produce or develop PrEP. The other authors declare that they have no competing interests.
Funding
EMIS-2017 was carried out as part of ESTICOM, under the service contract 2015 71 01 with the Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union.
Wave 1 and 2 of the PrApp study were funded by the Robert Koch Institute, Berlin, Germany. Wave 3 of the PrApp study was supported by a grant from the Federal Ministry of Health, Germany.
Authors' contributions
U.M. and S.B.S. contributed and analysed data from EMIS-2017, D.S. contributed and analysed drug prescription data, U.K. contributed data from the PrApp study. U.M. wrote the first draft of the main manuscript and prepared tables and figures, all authors contributed to consecutive drafts and reviewed the final manuscript.
Acknowledgements
We thank all EMIS-2017 study participants and collaborators for being part of something huge. EMIS-2017 was coordinated by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. The following list acknowledges all partners in EMIS by country. Individual names are mentioned if a freelancer was the main contact and/or translator or where input on the questionnaire development came from a person not formally representing an organisation. The order (if available) is main NGO partner, other NGO partners, academic partners, governmental partners, individuals. Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE). AL: Arian Boci. AT: Aids Hilfe Wien, Dr Frank M. Amort. BA: lgbti.ba, Masha Durkalić. BE: SENSOA, exaequo, Observatoire du SIDA et des sexualités, Sciensano. BG: HUGE, GLAS Foundation, Dr Emilia Naseva, Petar Tsintsarski. BY: Vstrecha. CA: Health Initiative for Men, Rézo, Gay Men’s Sexual Health Alliance of Ontario, CATIE, Ontario HIV Treatment Network, Université du Quebec & Montréal, University of Toronto, Ryerson University, University of Windsor, University of Victoria, Public Health Agency of Canada, Rob Gair. CH: Swiss AIDS Federation, Cantonal Hospital St. Gallen, Centre Hospitalier Universitaire Vaudois, University Hospital Zurich, Swiss Federal Office of Public Health. CY: AIDS Solidarity Movement. CZ: AIDS pomoc, National Institute of Public Health, Tereza Zvolska, Dr Michal Pitoňák. DE: Deutsche AIDS-Hilfe, Robert Koch Institute, BZgA, Dr Michael Bochow, Dr Richard Lemke. DK: AIDS-Fondet, Statens Serum Institut, François Pinchon, Jakob Haff. EE: Eesti LGBT, VEK LGBT, Estonia National Institute for Health Development, Dr Kristi Rüütel. ES: Stop Sida, CEEISCAT, Ministerio de Sanidad. FI: Positiiviset, Hivpoint, SeksiPertti, Trasek, National Institute for Health and Welfare. FR: AIDES, Coalition PLUS, SexoSafe, Santé Publique France, INSERM. GR: Ath Checkpoint, Thess Checkpoint; Positive Voice. HR: Iskorak, gay.hr, Zoran Dominković, Vjeko Vacek. HU: Háttér Society, Tamás Bereczky. IE: Gay Health Network, Man2Man, HIV Ireland, Outhouse, GOSHH, Sexual Health Centre Cork, AIDSWEST, Gay Community News, Health Service Executive, Gay Men's Health Service, Sexual Health and Crisis Pregnancy Programme, Health Protection Surveillance Centre. IL: Israel AIDS Task Force, Israel Ministry of Health, Dr Zohar Mor. IS: Samtökin'78. IT: Arcigay, Fondazione LILA Milano ONLUS, University of Verona, Dr Raffaele Lelleri. LB: SIDC, Dr Ismaël Maatouk. LT: demetra, LGL, Gayline. LV: Testpunkts, Baltic HIV Association, Dr Antons Mozalevskis, Indra Linina. MD: GENDERDOC-M. ME: Juventas. MK: Subversive Front, Dr Kristefer Stojanovski. MT: Malta LGBTIQ Rights Movement, Allied Rainbow Communities, Infectious Disease Prevention and Control Unit, Silvan Agius, Russel Sammut. NL: Results in Health, Maastricht University, Amsterdam Pink Panel, Soa Aids Nederland, Rutgers, Dr Wim Vanden Berghe, Marije Veenstra. NO: Helseutvalget, Norwegian Directorate of Health, Folkehelseinstituttet, Dr Rigmor C. Berg. PH: Bisdak Pride-Cebu, Cebu Plus, HASH, Pinoy Plus, UP Babaylanes, YPEER, TLF, Office of the WHO Representative in the Philippines, Natasha Montevirgen, Mikael N. Navarro. PL: Spoleczny Komitet ds AIDS, Kampania Przeciw Homofobii, Lambda Warszawa, Dr Łukasz Henszel. PT: GAT Portugal, CheckpointLX, Associação ABRAÇO, rede ex aequo, SexED, dezanove, ILGA Portugal, Trombeta Bath, ISPUP. RO: Association “Eu sunt! Tu?”, PSI Romania, ARAS Romania, Tudor Kovacs. RS: Association Duga, Association Red Line, Omladina JAZAS-a Novi Sad, Institute of Public Health of Serbia, Sladjana Baros, Dr Marija Pantelic. RU: The Charity Foundation For Support of Social Initiatives and Public Health/LaSky Project. SE: RFSL, University of Gothenburg, Folkhålsomyndigheten. SI: ŠKUC, Legebitra, LJUDMILA. SK: PRIDE Košice, Light-House Slovakia, Slovak Medical University, Public Health Authority of the Slovak Republic, Dr Zuzana Klocháňová. TR: Pozitif Yaşam, Sami S. Yazıcılaroğlu. UA: Alliance for Public Health, alliance.global, msmua.org, Oleksii Shestakovskyi. UK: Terrence Higgins Trust, NAM, PrEPster, Antidote, Horizon Drugs and Alcohol Support, LGBT Foundation, Yorkshire MESMAC, MESMAC Newcastle, Derbyshire LGBT+, Trade Sexual Health, London Friend, GMFA, Spectra, International HIV Partnerships, International Planned Parenthood Federation, Bristol University, University College London, Sigma Research, Raul Soriano. Other: Dr John Pachankis, Dr Mark Hatzenbühler, Dr Valeria Stuardo Ávila, Dr Michael W. Ross.
We thank all the participants of the PrApp study. We also thank the app providers from Grindr, Planetromeo, and Hornet, the website prepjetzt.de, and the participating anonymous testing sites for their support in recruiting the participants. We thank S. Arslan, B. Augustin, S. Boender, V. Briesemeister, A. Gamroth, M. Gassowski, B. Haboub, I. Markus, S. Marzogoui, L. Meurs, O. Panochenko, A. Pantke, E. Romo-Ventura, N. Saad, G. Sarganas Margolis, E. Willems, and T. Yilmaz for their support with translations.
We thank Emmanuel Danan for sharing the results of his survey on Facebook among PrEP users.