Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study

Date

2021

Authors

Cox, Joseph
Apelian, Herak
Moodie, Erica E. M.
Messier-Peet, Marc
Hart, Trevor A.
Grace, Daniel
Moore, David M.
Lachowsky, Nathan J.
Armstrong, Heather L.
Jollimore, Jody

Journal Title

Journal ISSN

Volume Title

Publisher

CMAJ Open

Abstract

Background: In Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Our objective was to describe access to HIV pre exposure prophylaxis (PrEP) and identify factors associated with not using PrEP among self-reported HIV-negative or HIV-unknown GBM. Methods: This was a cross-sectional analysis of the Engage study cohort. Between 2017 and 2019, sexually active GBM aged 16 years or more in Montréal, Toronto and Vancouver were recruited via respondent driven sampling (RDS). Participation included testing for HIV and sexually transmitted and blood-borne infections, and completion of a questionnaire. We examined PrEP access using a health care services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those for whom PrEP was clinically recommended and who were aware of the intervention. Results: A total of 2449 GBM were recruited, of whom 2008 were HIV-negative or HIV-unknown; 1159 (511 in Montréal, 247 in Toronto and 401 in Vancouver) met clinical recommendations for PrEP. Of the 1159, 1100 were aware of PrEP (RDS-adjusted proportion: Montréal 84.6%, Toronto 94.2%, Vancouver 92.7%), 678 had felt the need for PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 39.2%, Toronto 56.1%, Vancouver 49.0%), 406 had tried to access PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 20.6%, Toronto 33.2%, Vancouver 29.6%) and 319 had used PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 14.5%, Toronto 21.6%, Vancouver 21.8%). Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider and lacking medication insurance. Interpretation: Although half of GBM met clinical recommendations for PrEP, less than a quarter of them reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health care system barriers is needed to scale up PrEP access among GBM in Canada.

Description

The authors thank the Engage study participants, office staff and community engagement committee members, as well as their community partner agencies.

Keywords

Citation

Cox, J., Apelian, H., Moodie, E. E. M., Messier-Peet, M., Hart, T. A., Grace, D., Moore, D. M., Lachowsky, N. L., Armstrong, H. L., Jollimore, J., Skakoon-Sparling, S., Rodrigues, R., Tan, D. H. S., Maheu-Giroux, M., Noor, S. W., Lebouché, B., Tremblay, C., Olarewaju, G., Lambert, G., & Engage Study Team (2021). “Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study.” CMAJ Open, 9(2), e529-e538. DOI: https://doi.org/10.9778/cmajo.20200198