Awareness of HIV Pre-Exposure Prophylaxis Among Gay and Bisexual Men: Findings from the (i)Cruise Study

Background: The strategic application of HIV antiretroviral therapy for HIV prevention, such as pre-exposure prophylaxis (PrEP) has received increased attention and advocacy over the past few years. PrEP involves prescribing antiretroviral drugs to HIV-negative people to protect them from HIV infection, and has been shown to be effective in reducing HIV acquisition among gay and bisexual men (GBM). Awareness of, and use of PrEP may be redefining sexual practices among GBM. However little is known about the factors associated with awareness of PrEP among GBM in Canada who use online resources to obtain sexual health information. This study aims to examine the factors associated with a lack of awareness of PrEP among GBM who access online resources to obtain sexual health information.   

Methods: The study sample included 692 GBM (559 HIV-negative and 133 HIV-unknown status) living in Ontario, Canada enrolled in #iCruise, a study that examined how GBM interact with and experience online and app based sexual health outreach. Recruitment occurred from July-December 2017 and was conducted via websites, mobile-apps, social media, and community listservs. Demographics were collected and participants were asked “Before today, had you heard of pre-exposure prophylaxis or PrEP?”. Multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of factors associated with having little or no awareness about PrEP. A p<.05 was considered significant.

Results: The participants (n=692) were mostly <30 years old (55%), Caucasian (58%), gay identified (63%), born in Canada (71%), single and never married (64%), living in urban areas (88%), and employed (71%). Nearly a quarter (n=168;24%) had little/no awareness about PrEP (“had not heard the term” or “heard the term but don’t know what it is”) and 524 (76%) were very aware (heard the term and “familiar with it” or “know a lot about it”). In multivariable logistic regression analysis, factors independently associated (p<0.05) with little/no awareness of PrEP were being 50+ years compared to younger groups (aOR= 3.1, 95% CI: 1.69 to 5.61), identifying as bisexual (aOR=2.5, 95% CI: 1.49 to 4.33) or “other” (aOR=1.6, 95% CI: 1.01 to 2.50) compared to gay, completing high school or less education compared to those with more education (aOR=2.7, 95% CI: 1.53 to 4.79), and living in a rural compared to urban area (aOR=2.3, 95% CI: 1.35 to 3.92). 

Conclusion and Implications: Older, non-gay identified GBM with lower levels of education, who live in rural areas have less awareness about PrEP. The current findings necessitate that social workers pay attention to the need to both prioritize and better understand how to strengthen the bridge between biomedical advances such as PrEP and community uptake of these advances. Social workers should educate themselves, GBM and their providers about prescription guidelines for PrEP and advocate for increased accessibility of PrEP for sexually active GBM. These findings also highlight the need for individual- and structural-level social work interventions tailored to address the unique barriers GBM face at each stage of the HIV treatment, care, and prevention cascade