The Awareness, Usage, and Perceptions of Doxycycline Post-Exposure Prophylaxis (doxyPEP) study was a cross-sectional online survey conducted across multiple sites in Australia, which aimed to examine the awareness, usage, and perceptions of doxyPEP for sexually transmitted infection prevention among gay and bisexual men and transgender and gender diverse people. Individuals aged 18 years or above living in Australia were eligible to participate. A total of 2095 participants completed the survey between 1 July 2024 and 30 November 2024.
About the study
The DoxyAWARE study is being run by the Melbourne Sexual Health Centre (MSHC) and Monash University in collaboration with researchers from Sydney Sexual Health Centre, Gold Coast Sexual Health Service, a[test], Adelaide Sexual Health Centre, Canberra Sexual Health Centre, M Clinic, Clinic 34, North Coast Sexual Health and HIV Services, UNSW Kirby Institute, The University of Melbourne, Burnet Institute, Maastricht University (the Netherlands) and The University of Toronto (Canada); and representatives from ASHM Health (the peak body representing healthcare professionals in HIV, sexual and reproductive health) and Health Equity Matters (the national peak body for the HIV community-controlled response).
The ethical aspects of this research project have been approved by the Alfred Hospital Ethics Committee (Ethics approval number: 107/24). This project has also been reviewed and approved by LGBTIQA+ community health organisations including ACON (202405) and Thorne Harbour Health (THH_2024_010).
Main Findings
- About half (51.6%) of the 2,095 Australian gay and bisexual men and transgender and gender diverse people surveyed had heard of doxyPEP. Of those aware, nearly one in three (29.9%) had ever used it, with use highest among people living with HIV and those on HIV PrEP. Friends were the most common way people found out, but healthcare professionals were the most trusted source.
- Most users (63.5%) took the correct dose of 200 mg within 72 hours after sex. However, one in three used a non-recommended dosing schedule, and nearly half obtained doxyPEP without a prescription, sourcing it from friends, leftover antibiotics, or buying it online or overseas without seeing a doctor.
- Most people took doxyPEP to reduce their STI risk (83.3%) or avoid injections for STI treatment (62.2%), rather than because a clinician recommended it (16.1%). Use was more strongly driven by situational factors like attending sex parties than by a recent STI diagnosis as guidelines recommend.
- Most users (81.4%) believed doxyPEP would prevent gonorrhoea, despite limited evidence for this. Some intended to use it to prevent HIV (10.2%) or mpox (7.4%), which it does not protect against. Among non-users, 41.3% cited not having enough information as their main barrier, and around one in three worried about antibiotic resistance.
Researchers
Principal investigator
Associate investigators
Research nurse
Participating clinics
Melbourne Sexual Health Centre, Centre Clinic, Prahran Market Clinic, Doctors of South Melbourne, Sydney Sexual Health Centre, a[Test], North Coast NSW Sexual Health Service, Tweed Valley Sexual Health Service, Specialist Medical Centre Coffs Harbour, Northern Sydney Area Health Service, Canberra Sexual Health Centre, Ochre Medical Centre Bruce, East Canberra General Practice, Adelaide Sexual Health Centre, Gold Coast Sexual Health Service, Rapid Clinic, Metro North Sexual Health and HIV Service, Clinic 34, M Clinic, South Terrace Clinic, and View Street Medical.
Community partners
The following LGBTQIA+ community-led organisations helped promote the DoxyAWARE study through their networks: Thorne Harbour Health, Living Positive Victoria, Health Equity Matters, ACON, Queensland Positive People, Positive Life NSW, Tasmanian Council on AIDS, Hepatitis and Related Diseases, and ASHM Health.