Design and methods of the "Understanding pre-exposure prophylaxis modalities for HIV prevention in European communities" (PROTECT) survey-exploring the sexual health of men who have sex with men, trans and non-binary people

Background: European men who have sex with men (MSM), trans* and non-binary individuals experience unique sexual health challenges and are disproportionally affected by HIV. Despite efforts to improve sexual health among these communities, gaps remain in the coverage of HIV prevention strategies at a population level. Methods: An online cross-sectional survey was conducted across 20 European countries from October 2023 to April 2024. The survey was translated into 22 local and migrant languages. The survey was designed to understand the sociodemographic characteristics, sexual behavior, sexual health and the use of HIV prevention strategies among MSM, trans* and non-binary individuals in Europe. Participants were recruited mainly from gay dating apps and through a social media campaign. Results: A total of 15,458 MSM, trans* and non-binary individuals participated in the survey and were included in this sample. Overall, the sample was sexually active in the past 6 months (96.4%), engaged in condomless anal intercourse in the past 6 months (83.4%), had more than 10 partners in the past 6 months (57.6%) and was PrEP na & iuml;ve (51.4%). Conclusions: MSM, trans* and non-binary individuals in Europe are sexually active and are employing a range of strategies to protect themselves from HIV, including oral PrEP, however gaps remain in HIV prevention coverage, which new PrEP modalities, such as long-acting injectable PrEP, could help to fill.