{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:14:48Z","timestamp":1792804488947,"version":"4.5.0"},"reference-count":37,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T00:00:00Z","timestamp":1658275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Commission Health Programme 2014\u20132020","id":[{"id":"https:\/\/ror.org\/00k4n6c32","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called \u201cRandstad\u201d, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0\u201310.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04\u20134.4). Lower education (aOR = 0.4, 95% CI 0.2\u20130.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7\u20132.0) and high education. We showed that regional differences\u2014MSM in non-urban regions\u2014and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention\/use can be conducted among target populations.<\/jats:p>","DOI":"10.3390\/ijerph19148829","type":"journal-article","created":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T11:22:24Z","timestamp":1658316144000},"page":"8829","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1844-7156","authenticated-orcid":false,"given":"Haoyi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3371-4515","authenticated-orcid":false,"given":"Oladipupo","family":"Shobowale","sequence":"additional","affiliation":[{"name":"Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0955-3691","authenticated-orcid":false,"given":"Chantal","family":"den Daas","sequence":"additional","affiliation":[{"name":"Health Psychology, University of Aberdeen, Aberdeen AB24 3 FX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8263-9187","authenticated-orcid":false,"given":"Eline","family":"Op de Coul","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bouko","family":"Bakker","sequence":"additional","affiliation":[{"name":"Rutgers, 3511 MJ Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aryanti","family":"Radyowijati","sequence":"additional","affiliation":[{"name":"ResultsinHealth, 2352 BN Leiderdorp, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koenraad","family":"Vermey","sequence":"additional","affiliation":[{"name":"Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjan","family":"van Bijnen","sequence":"additional","affiliation":[{"name":"Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Zuilhof","sequence":"additional","affiliation":[{"name":"Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6607-1993","authenticated-orcid":false,"given":"Kai J.","family":"Jonas","sequence":"additional","affiliation":[{"name":"Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,20]]},"reference":[{"key":"ref_1","unstructured":"Van Sighem, A.I.W.F., Boyd, A., Smit, C., Matser, A., and Reiss, P. (2022, May 17). Monitoring Report 2020. Human Immunodeficiency Virus (HIV) Infection in the Netherlands. Amsterdam: Stichting HIV Monitoring. Available online: https:\/\/www.hiv-monitoring.nl\/en\/resources\/monitoring-reports."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0140-6736(15)00056-2","article-title":"Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial","volume":"387","author":"McCormack","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1056\/NEJMoa1011205","article-title":"Preexposure chemoprophylaxis for HIV prevention in men who have sex with men","volume":"363","author":"Grant","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1097\/QAD.0000000000001627","article-title":"Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries","volume":"31","author":"Hoornenborg","year":"2017","journal-title":"AIDS"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e447","DOI":"10.1016\/S2352-3018(19)30136-5","article-title":"Sexual behaviour and incidence of HIV and sexually transmitted infections among men who have sex with men using daily and event-driven pre-exposure prophylaxis in AMPrEP: 2 year results from a demonstration study","volume":"6","author":"Hoornenborg","year":"2019","journal-title":"Lancet HIV"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S1473-3099(14)70847-3","article-title":"Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: A cohort study","volume":"14","author":"Grant","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1007\/s10508-019-01620-x","article-title":"PrEP interest among men who have sex with men in the Netherlands: Covariates and differences across samples","volume":"49","author":"Duken","year":"2020","journal-title":"Arch. Sex. Behav."},{"key":"ref_8","unstructured":"GGD-Amsterdam (2022, May 17). STI, HIV and Sense\u2014PrEP 2019. Available online: https:\/\/www.ggd.amsterdam.nl\/english\/sti-hiv-sense\/prep\/#:~:text=Dutch%20National%20programme%202019,are%20at%20risk%20for%20HIV."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e25708","DOI":"10.1002\/jia2.25708","article-title":"Adherence to event-driven HIV PrEP among men who have sex with men in Amsterdam, the Netherlands: Analysis based on online diary data, 3-monthly questionnaires and intracellular TFV-DP","volume":"24","author":"Jongen","year":"2021","journal-title":"J. Int. AIDS Soc."},{"key":"ref_10","unstructured":"ECDC (2022, May 17). Pre-exposure Prophylaxis for HIV Prevention in Europe and Central Asia. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/HIV-pre-exposure-prophylaxis-evidence-2019_0.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"188","DOI":"10.3389\/fpubh.2018.00188","article-title":"Pre-exposure Prophylaxis: The delivery challenge","volume":"6","author":"Venter","year":"2018","journal-title":"Front. Public Health"},{"key":"ref_12","unstructured":"RIVM (2022, May 17). PrEP 2021. Available online: https:\/\/www.rivm.nl\/Soa-seksueel-overdraagbare-aandoening\/prep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1097\/QAD.0000000000000639","article-title":"What do Dutch MSM think of preexposure prophylaxis to prevent HIV-infection? A cross-sectional study","volume":"29","author":"Bil","year":"2015","journal-title":"AIDS"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2382","DOI":"10.1007\/s10461-021-03200-4","article-title":"Slow uptake of PrEP: Behavioral predictors and the influence of price on PrEP uptake among MSM with a high interest in PrEP","volume":"25","author":"Guadamuz","year":"2021","journal-title":"AIDS Behav."},{"key":"ref_15","first-page":"303","article-title":"Quality of sex life and perceived sexual pleasure of PrEP users in the Netherlands","volume":"59","author":"Guadamuz","year":"2020","journal-title":"J. Sex Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Coyer, L., Van Bilsen, W., Bil, J., Davidovich, U., Hoornenborg, E., Prins, M., and Matser, A. (2018). Pre-exposure prophylaxis among men who have sex with men in the Amsterdam Cohort Studies: Use, eligibility, and intention to use. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205663"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1007\/s10461-020-03109-4","article-title":"The rhythm of risk: Sexual behaviour, PrEP use and HIV risk perception between 1999 and 2018 among men who have sex with men in Amsterdam, The Netherlands","volume":"25","author":"Basten","year":"2020","journal-title":"AIDS Behav."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s10461-019-02657-8","article-title":"Temporal trends and sociodemographic correlates of PrEP uptake in Tennessee, 2017","volume":"23","author":"Brantley","year":"2019","journal-title":"AIDS Behav."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3389\/fpubh.2018.00005","article-title":"The acceptability of pre-exposure prophylaxis: Beliefs of health-care professionals working in sexually transmitted infections clinics and HIV treatment centers","volume":"6","author":"Bil","year":"2018","journal-title":"Front. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1080\/09540121.2020.1762067","article-title":"Racial and ethnic differences in women\u2019s HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic","volume":"33","author":"Willie","year":"2021","journal-title":"AIDS Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/QAI.0000000000001164","article-title":"Brief report: PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications","volume":"74","author":"Holloway","year":"2017","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1136\/sextrans-2018-053705","article-title":"Use of, and likelihood of using, HIV pre-exposure prophylaxis among men who have sex with men in Europe and Central Asia: Findings from a 2017 large geosocial networking application survey","volume":"95","author":"Bourne","year":"2019","journal-title":"Sex. Transm. Infect."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4102","DOI":"10.1007\/s10461-021-03267-z","article-title":"Differences in PrEP awareness, discussions with healthcare providers, and use among men who have sex with men in the United States by urbanicity and region: A cross-sectional analysis","volume":"25","author":"Rossiter","year":"2021","journal-title":"AIDS Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s10461-020-02961-8","article-title":"Sexual health of rural and urban young male couples in the United States: Differences in HIV testing, pre-exposure prophylaxis use, and condom use","volume":"25","author":"Sarno","year":"2021","journal-title":"AIDS Behav."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1007\/s10461-021-03488-2","article-title":"PrEP care continuum engagement among persons who inject drugs: Rural and urban differences in stigma and social infrastructure","volume":"26","author":"Walters","year":"2022","journal-title":"AIDS Behav."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/s13178-019-00413-0","article-title":"European men-who-have-sex-with-men internet survey (EMIS-2017): Design and methods","volume":"17","author":"Weatherburn","year":"2020","journal-title":"Sex. Res. Soc. Policy"},{"key":"ref_27","first-page":"613","article-title":"An ultra-brief screening scale for anxiety and depression: The PHQ-4","volume":"50","author":"Kroenke","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1177\/0013164403261814","article-title":"A reliability induction and reliability generalization study of the cage questionnaire","volume":"64","author":"Shields","year":"2004","journal-title":"Educ. Psychol. Meas."},{"key":"ref_29","first-page":"336","article-title":"Multilevel regression modelling to investigate variation in disease prevalence across locations","volume":"46","author":"Weinmayr","year":"2016","journal-title":"Int. J. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/S1473-3099(16)30311-5","article-title":"Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: A mathematical modelling study","volume":"16","author":"Nichols","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1071\/SH18103","article-title":"Getting pre-exposure prophylaxis (PrEP) to the people: Opportunities, challenges and emerging models of PrEP implementation","volume":"15","author":"Sullivan","year":"2018","journal-title":"Sex. Health"},{"key":"ref_32","unstructured":"PrEPnu (2022, May 17). Ik slik, slik jij?. Available online: https:\/\/www.prepnu.nl\/."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e25105","DOI":"10.1002\/jia2.25105","article-title":"Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: Baseline analysis of a demonstration study in Amsterdam","volume":"21","author":"Hoornenborg","year":"2018","journal-title":"J. Int. AIDS Soc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3681","DOI":"10.1007\/s10461-018-2184-4","article-title":"Improving PrEP implementation through multilevel interventions: A synthesis of the literature","volume":"22","author":"Pinto","year":"2018","journal-title":"AIDS Behav."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2358","DOI":"10.1007\/s10461-015-1180-1","article-title":"Where you live matters: Structural correlates of HIV risk behavior among young men who have sex with men in Metro Detroit","volume":"19","author":"Bauermeister","year":"2015","journal-title":"AIDS Behav."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wang, H., den Daas, C., de Coul, E.O., and Jonas, K.J. (2022). MSM with HIV: Improving prevalence and risk estimates by a Bayesian small area estimation modelling approach for public health service areas in the Netherlands. medRxiv.","DOI":"10.1101\/2022.05.20.22275273"},{"key":"ref_37","unstructured":"GGD-Amsterdam (2022, May 17). National PrEP Programme. Available online: https:\/\/www.ggd.amsterdam.nl\/english\/sti-hiv-sense\/prep\/national-prep-program\/."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/14\/8829\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:54:59Z","timestamp":1760140499000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/14\/8829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,20]]},"references-count":37,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["ijerph19148829"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19148829","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202205.0271.v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,20]]}}}