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Across countries, men who have sex with men (MSM) continue to be disproportionally affected by HIV. Social inequalities as well as unmet prevention needs may influence their HIV-related protection behavior. Various studies have evidenced a positive association between MSM’s disclosure of their sexual attraction to men (‘outness’) and their condom use. In this light, we focused on PrEP awareness and PrEP use among MSM in Switzerland. We assumed that MSM reporting extensive disclosure of their same sex sexual attraction would also report higher levels of PrEP awareness and use.
Method
The European MSM Internet Survey (EMIS-2017) surveyed 137,358 MSM in 50 countries. Our analysis is based on 3,066 respondents living in Switzerland that passed the internal validity tests. We analyzed the data using descriptive statistics. The level of outness was assessed using a 5-point Likert scale. For this analysis, we dichotomized the scale into ‘restricted disclosure’ (having disclosed to ‘none’, a ‘few’ or ‘less than half’) and ‘extensive disclosure’ (having disclosed to ‘more than half’ or ‘all or almost all’ people who knew them, including family members, friends, work and study colleagues). To identify the association between participants’ level of outness and their PrEP awareness and use, we performed logistic regression analyses, controlling the effect of disclosure for age, education, financial coping, employment, settlement size, and relationship status.
Results
Respondents’ ages ranged from 16 to 85 years (Md = 41; IQR=31-51). The majority of respondents reported that they were out to ‘all or almost all’ (51.2%, n=1551) or ‘more than half’ (17.6%, n=533) of the people who knew them. Nevertheless, 8.2% (n=247) had disclosed their sexual orientation to ‘less than half’ and 14.7% (n=444) to a ‘few’ people including family members, friends, work and study colleagues while 8.4% (n=254) had disclosed it to nobody who knew them. Thus, a proportion of 31.2% (n=945) reported a restricted disclosure.
Analysis showed that the odds of being aware of PrEP were 2.9 times higher among MSM who reported an extensive disclosure (95% CI=2.4–3.5; p<.001) than among those who reported a restricted disclosure. The odds of PrEP use were more than four times higher among MSM who reported an extensive disclosure (OR=4.5; 95% CI=2.4–8.5; p<≤.001) than among MSM who reported a restricted disclosure.
Conclusions
The findings suggest that among MSM, extensive disclosure is associated with higher levels of PrEP awareness and PrEP use. This finding regarding PrEP is in line with previous evidence of an association between MSM’s outness and their condom use. This finding is of relevance for the design and development of tailored HIV prevention interventions for MSM. A coming-out process remains a daunting challenge in a heteronormative society. However, in further life ‘being out’ seems to turn into an enabling resource which strengthens HIV-protective behaviors. Social work counselling should empower MSM regarding a possible coming-out and support their process towards self-acceptance while engaging in advocacy, challenging homonegativity and furthering an accepting social climate.