Community awareness of, use of and attitudes towards HIV pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: preparing health promotion for a publicly funded PrEP program
Nathan J. Lachowsky A B E , Tessa Lawson Tattersall B , Paul Sereda![https://orcid.org/0000-0002-6411-8089](/media/client/orcid_16x16.png)
A British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
B School of Public Health & Social Policy, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
C Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
D Health Initiative for Men, 310–1033 Davie Street, Vancouver, BC V6E 1M7, Canada.
E Corresponding author. Email: nlachowsky@cfenet.ubc.ca
Sexual Health 16(2) 180-186 https://doi.org/10.1071/SH18115
Submitted: 20 June 2018 Accepted: 15 August 2018 Published: 21 January 2019
Abstract
Background: HIV rates are persistently disproportionate among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, now publicly funded in British Columbia. This study assessed PrEP-related attitudes, sexual behaviour and self-reported use before public funding. Methods: Adult MSM were recruited from January to June 2017 through a local community-based organisation’s PrEP campaign website (www.getpreped.ca). Participants self-completed an anonymous online questionnaire, and were stratified into three groups: (i) HIV-positive participants; (ii) HIV-negative participants not using PrEP; and (iii) HIV-negative participants using PrEP. Descriptive, bivariate and univariate regression analyses were conducted. Results: Of 249 participants, 191 (77%) were HIV-negative not using PrEP, 41 (17%) were HIV-negative using PrEP and 17 (7%) were HIV-positive. Among PrEP users, 90% used PrEP daily and all reported having recommended medical follow-up care. Among HIV-negative, non-PrEP-users, 44% said they would reduce condom use if they used PrEP and 28% were uncomfortable asking their doctor for PrEP. Interest in PrEP among non-users was associated with higher objective risk scores (i.e. HIV Incidence Risk Index for MSM), higher self-perceived risk, greater perceived PrEP effectiveness, no prescription medications insurance, open or single relationship status (vs closed) and not always using condoms (vs always). Among HIV-positive participants, 53% agreed PrEP reduced stigma for people living with HIV. All study groups perceived a greater percentage of MSM on PrEP (10%, 15%, 18%) than in their own social networks (5%, 4%, 6%). Conclusions: PrEP health promotion must consider comprehensive PrEP education; accuracy of self-perceived HIV risk and PrEP social norms; and barriers to culturally safe primary care for MSM.
Additional keywords: community health, health education, health equity, HIV/AIDS, HIV prevention.
References
[1] British Columbia Centre for Disease Control (BCCDC). HIV Annual Report. Vancouver: BCCDC; 2017. Available online at: http://www.bccdc.ca/resource-gallery/Documents/Statistics and Research/Statistics and Reports/STI/HIV_Annual_Report_2015-FINAL.pdf [verified 19 March 2018].[2] Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep 2011; 8 62–72.
| Combination HIV prevention: significance, challenges, and opportunities.Crossref | GoogleScholarGoogle Scholar | 20941553PubMed |
[3] British Columbia Centre for Excellence in HIV/AIDS (BCCfE). Guidance for the use of pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia. Vancouver: BCCfE; 2017. Available online at: http://cfenet.ubc.ca/sites/default/files/uploads/publications/centredocs/prep_guidelines_-_07sep2018.pdf [verified 16 December 2018].
[4] Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, Goicochea P, Casapía M, Guanira-Carranza JV, Ramirez-Cardich ME, Montoya-Herrera O, Fernández T, Veloso VG, Buchbinder SP, Chariyalertsak S, Schechter M, Bekker L-G, Mayer KH, Kallás EG, Amico KR, et al Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363 2587–99.
| Preexposure chemoprophylaxis for HIV prevention in men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 21091279PubMed |
[5] Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, et al Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367 399–410.
| Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.Crossref | GoogleScholarGoogle Scholar | 22784037PubMed |
[6] Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, Henderson FL, Pathak SR, Soud FA, Chillag KL, Mutanhaurwa R, Chirwa LI, Kasonde M, Abebe D, Buliva E, Gvetadze RJ, Johnson S, Sukalac T, Thomas VT, Hart C, et al Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012; 367 423–34.
| Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana.Crossref | GoogleScholarGoogle Scholar | 22784038PubMed |
[7] Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, Chuachoowong R, Gvetadze RJ, McNicholl JM, Paxton LA, Curlin ME, Hendrix CW, Vanichseni S, for the Bangkok Tenofovir Study Group. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2013; 381 2083–90.
| Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.Crossref | GoogleScholarGoogle Scholar | 23769234PubMed |
[8] McCormack S, Dunn DT, Desai M, Dolling DI, Gafos M, Gilson R, Sullivan AK, Clarke A, Reeves I, Schembri G, Mackie N, Bowman C, Lacey CJ, Apea V, Brady M, Fox J, Taylor S, Antonucci S, Khoo SH, Rooney J, et al 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. Lancet 2016; 387 53–60.
| 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.Crossref | GoogleScholarGoogle Scholar | 26364263PubMed |
[9] Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, Tremblay C, Le Gall J-M, Cua E, Pasquet A, Raffi F, Pintado C, Chidiac C, Chas J, Charbonneau P, Delaugerre C, Suzan-Monti M, Loze B, Fonsart J, Peytavin G, et al On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med 2015; 373 2237–46.
| On-demand preexposure prophylaxis in men at high risk for HIV-1 infection.Crossref | GoogleScholarGoogle Scholar | 26624850PubMed |
[10] Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013; 12 18
| Patient-centred access to health care: conceptualising access at the interface of health systems and populations.Crossref | GoogleScholarGoogle Scholar | 23496984PubMed |
[11] Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDS 2013; 27 248–54.
| From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City.Crossref | GoogleScholarGoogle Scholar | 23565928PubMed |
[12] Chan PA, Glynn TR, Oldenburg CE, Montgomery MC, Robinette AE, Almonte A, Raifman J, Mena L, Patel R, Mayer KH, Beauchamps LS, Nunn AS. Implementation of preexposure prophylaxis for human immunodeficiency virus prevention among men who have sex with men at a New England sexually transmitted diseases clinic. Sex Transm Dis 2016; 43 717–23.
| Implementation of preexposure prophylaxis for human immunodeficiency virus prevention among men who have sex with men at a New England sexually transmitted diseases clinic.Crossref | GoogleScholarGoogle Scholar | 27893604PubMed |
[13] Lachowsky NJ, Lin SY, Hull MW, Cui Z, Sereda P, Jollimore J, Rich A, Montaner JSG, Roth EA, Hogg RS, Moore DM. Pre-exposure prophylaxis awareness among gay and other men who have sex with men in Vancouver, British Columbia, Canada. AIDS Behav 2016; 20 1408–22.
| Pre-exposure prophylaxis awareness among gay and other men who have sex with men in Vancouver, British Columbia, Canada.Crossref | GoogleScholarGoogle Scholar | 26884310PubMed |
[14] Lelutiu-Weinberger C, Golub SA. Enhancing PrEP access for black and Latino men who have sex with men. J Acquir Immune Defic Syndr 2016; 73 547–55.
| Enhancing PrEP access for black and Latino men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 27454250PubMed |
[15] Oldenburg CE, Le B, Huyen HT, Thien DD, Quan NH, Biello KB, Nunn A, Chan PA, Mayer KH, Mimiaga MJ, Colby D. Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey. Sex Health 2016; 13 465–73.
| Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
[16] Biello KB, Oldenburg CE, Mitty JA, Closson EF, Mayer KH, Safren SA, Mimiaga MJ. The “Safe Sex” conundrum: anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex. AIDS Behav 2017; 21 300–6.
| The “Safe Sex” conundrum: anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex.Crossref | GoogleScholarGoogle Scholar | 27351194PubMed |
[17] Stahlman S, Lyons C, Sullivan PS, Mayer KH, Hosein S, Beyrer C, Baral SD. HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading? Sex Health 2017; 14 5–17.
| HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?Crossref | GoogleScholarGoogle Scholar | 27491699PubMed |
[18] Holt M, Lea T, Kippax S, Kolstee J, Ellard J, Velecky M, Murphy D, de Wit J. Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey. Sex Health 2016; 13 359–365.
| Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey.Crossref | GoogleScholarGoogle Scholar |
[19] Wilton J, Kain T, Fowler S, Hart TA, Grennan T, Maxwell J, Tan DHS. Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk. J Int AIDS Soc 2016; 19 20777
| Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk.Crossref | GoogleScholarGoogle Scholar | 27265490PubMed |
[20] Clement ME, Seidelman J, Wu J, Alexis K, McGee K, Okeke NL, Samsa G, McKellar M. An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S. AIDS Care 2018; 30 650–5.
| An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S.Crossref | GoogleScholarGoogle Scholar | 28971705PubMed |
[21] Holloway IW, Dougherty R, Gildner J, Beougher SC, Pulsipher C, Montoya JA, Plant A, Leibowitz A. PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications. J Acquir Immune Defic Syndr 2017; 74 15–20.
| PrEP uptake, adherence, and discontinuation among California YMSM using geosocial networking applications.Crossref | GoogleScholarGoogle Scholar | 27552158PubMed |
[22] Smith DK, Pals SL, Herbst JH, Shinde S, Carey JW. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr 2012; 60 421–7.
| Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States.Crossref | GoogleScholarGoogle Scholar | 22487585PubMed |
[23] Morris MW, Chiu C, Liu Z. Normology: integrating insights about social norms to understand cultural dynamics. Organ Behav Hum Decis Process 2015; 129 1–13.
| Normology: integrating insights about social norms to understand cultural dynamics.Crossref | GoogleScholarGoogle Scholar |
[24] Lapinski MK. An explication of social norms. Commun Theory 2005; 15 127–47.
| An explication of social norms.Crossref | GoogleScholarGoogle Scholar |
[25] Wang Z, Lau JTF, Fang Y, Ip M, Gross DL. Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China. Gao L, editor. PLoS One 2018; 13(2): e0191671.
[26] Goedel WC, Halkitis PN, Greene RE, Hickson DA, Duncan DT. HIV risk behaviors, perceptions, and testing and preexposure prophylaxis (PrEP) awareness/use in Grindr-using men who have sex with men in Atlanta, Georgia. J Assoc Nurses AIDS Care 2016; 27 133–42.
| HIV risk behaviors, perceptions, and testing and preexposure prophylaxis (PrEP) awareness/use in Grindr-using men who have sex with men in Atlanta, Georgia.Crossref | GoogleScholarGoogle Scholar | 26708834PubMed |
[27] Knight R, Small W, Carson A, Shoveller J. Complex and conflicting social norms: implications for implementation of future HIV pre-exposure prophylaxis (PrEP) interventions in Vancouver, Canada. PLoS One 2016; 11 e0146513
| Complex and conflicting social norms: implications for implementation of future HIV pre-exposure prophylaxis (PrEP) interventions in Vancouver, Canada.Crossref | GoogleScholarGoogle Scholar | 27941990PubMed |
[28] Jaspal R, Daramilas C. Perceptions of pre-exposure prophylaxis (PrEP) among HIV-negative and HIV-positive men who have sex with men (MSM). Cogent Med 2016; 3 1256850
[29] Frankis J, Young I, Flowers P, McDaid L. Who will use pre-exposure prophylaxis (PrEP) and why?: understanding PrEP awareness and acceptability amongst men who have sex with men in the UK - a mixed methods study. PLoS One 2016; 11 e0151385
| Who will use pre-exposure prophylaxis (PrEP) and why?: understanding PrEP awareness and acceptability amongst men who have sex with men in the UK - a mixed methods study.Crossref | GoogleScholarGoogle Scholar | 27093430PubMed |
[30] Latkin C, Donnell D, Liu T-Y, Davey-Rothwell M, Celentano D, Metzger D. The dynamic relationship between social norms and behaviors: the results of an HIV prevention network intervention for injection drug users. Addiction 2013; 108 934–43.
| The dynamic relationship between social norms and behaviors: the results of an HIV prevention network intervention for injection drug users.Crossref | GoogleScholarGoogle Scholar | 23362861PubMed |
[31] Ramallo J, Kidder T, Albritton T, Blick G, Pachankis J, Grandeleski V, Kershaw T. Exploring social networking technologies as tools for HIV prevention for men who have sex with men. AIDS Educ Prev 2015; 27 298–311.
| Exploring social networking technologies as tools for HIV prevention for men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 26241381PubMed |
[32] Toghianifar N, Sarrafzadegan N, Gharipour M. Womenʼs attitude toward smoking. Int J Evid-Based Healthc 2014; 12 262–6.
| Womenʼs attitude toward smoking.Crossref | GoogleScholarGoogle Scholar | 25478675PubMed |
[33] Ward BW, Allen A, Gryczynski J. Racial/ethnic differences in the relationship among cigarette use, religiosity, and social norms for U.S. adolescents. J Ethn Subst Abuse 2014; 13 337–61.
| Racial/ethnic differences in the relationship among cigarette use, religiosity, and social norms for U.S. adolescents.Crossref | GoogleScholarGoogle Scholar | 25397636PubMed |
[34] Ridout B, Campbell A. Using Facebook to deliver a social norm intervention to reduce problem drinking at university. Drug Alcohol Rev 2014; 33 667–73.
| Using Facebook to deliver a social norm intervention to reduce problem drinking at university.Crossref | GoogleScholarGoogle Scholar | 24689339PubMed |
[35] Mahalik JR, Lombardi CM, Sims J, Coley RL, Lynch AD. Gender, male-typicality, and social norms predicting adolescent alcohol intoxication and marijuana use. Soc Sci Med 2015; 143 71–80.
| Gender, male-typicality, and social norms predicting adolescent alcohol intoxication and marijuana use.Crossref | GoogleScholarGoogle Scholar | 26344125PubMed |
[36] Uthappa CK, Allam RR, Pant R, Pal S, Dinaker M, Oruganti G, Yeldandi VV. Pre-exposure prophylaxis: awareness, acceptability and risk compensation behaviour among men who have sex with men and the transgender population. HIV Med 2018; 19 243–51.
| 29178158PubMed |
[37] Frankis JS, Young I, Lorimer K, Davis M, Flowers P. Towards preparedness for PrEP: PrEP awareness and acceptability among MSM at high risk of HIV transmission who use sociosexual media in four Celtic nations: Scotland, Wales, Northern Ireland and the Republic of Ireland: an online survey. Sex Transm Infect 2016; 92 279–85.
| Towards preparedness for PrEP: PrEP awareness and acceptability among MSM at high risk of HIV transmission who use sociosexual media in four Celtic nations: Scotland, Wales, Northern Ireland and the Republic of Ireland: an online survey.Crossref | GoogleScholarGoogle Scholar | 26801225PubMed |
[38] Chen Y-H, Snowden JM, McFarland W, Raymond HF. Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014. AIDS Behav 2016; 20 2791–7.
| Pre-exposure prophylaxis (PrEP) use, seroadaptation, and sexual behavior among men who have sex with men, San Francisco, 2004–2014.Crossref | GoogleScholarGoogle Scholar | 26983951PubMed |
[39] Tan DHS, Hull MW, Yoong D, Tremblay C, O’Byrne P, Thomas R, Kille J, Baril J-G, Cox J, Giguere P, Harris M, Hughes C, MacPherson P, O’Donnell S, Reimer J, Singh A, Barrett L, Bogoch I, Jollimore J, Lambert G, et al Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ 2017; 189 E1448–58.
| Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis.Crossref | GoogleScholarGoogle Scholar | 29180384PubMed |