Skip to main content

Advertisement

SpringerLink
Log in

Measures of HIV Pre-exposure Prophylaxis Uptake Among Gay, Bisexual, and Other Men Who Have Sex with Men in Canada and Demographic Disparities Among Those at Elevated Likelihood for HIV Acquisition

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30–49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Haddad N, Weeks A, Robert A, Totten S. HIV Surveillance Report 2019. CCDR. 2021;47(1):77–86.

    Article  Google Scholar 

  2. Canada S. Census Profile. 2016. Census. Statistics Canada Catalogue no. 98–316-X2016001. Ottawa2017. Available from: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/index.cfm?Lang=E.

  3. Riddell J IV, Amico KR, Mayer KH. HIV preexposure prophylaxis: a review. JAMA. 2018;319(12):1261–8.

    Article  Google Scholar 

  4. Chou R, Evans C, Hoverman A, Sun C, Dana T, Bougatsos C, et al. Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the us preventive services task force. JAMA. 2019;321(22):2214–30.

    Article  Google Scholar 

  5. Wilton J, Senn H, Sharma M, Tan DH. Pre-exposure prophylaxis for sexually-acquired HIV risk management: a review. HIV/AIDS (Auckland, NZ). 2015;7:125–36.

    Google Scholar 

  6. Health Canada. Notice of Compliance information: Government of Canada; 2016. Available from: https://health-products.canada.ca/noc-ac/info.do?lang=en&no=17808.

  7. Hull M, Tan DHS. Setting the stage for expanding HIV pre-exposure prophylaxis use in Canada. Can Commun Dis Rep. 2017;43(12):272–8.

    Article  CAS  Google Scholar 

  8. Sharma M, Chris A, Chan A, Knox DC, Wilton J, McEwen O, et al. Decentralizing the delivery of HIV pre-exposure prophylaxis (PrEP) through family physicians and sexual health clinic nurses: a dissemination and implementation study protocol. BMC Health Serv Res. 2018. https://doi.org/10.1186/s12913-018-3324-2.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Arkell C. Oral pre-exposure prophylaxis (PrEP): Canadian AIDS Treatment Information Exchange; 2017; Available from: http://www.catie.ca/en/fact-sheets/prevention/pre-exposure-prophylaxis-prep.

  10. Purchasing Power Parities (PPP): Organisation for Economic Co-operation and Development; 2020 Available from: https://data.oecd.org/conversion/purchasing-power-parities-ppp.htm.

  11. PrEP Access and Coverage: Canadian AIDS Treatment Information Exchange; Available from: https://www.catie.ca/en/prep/access.

  12. Levesque JF, 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.

    Article  Google Scholar 

  13. Hannaford A, Lipshie-Williams M, Starrels JL, Arnsten JH, Rizzuto J, Cohen P, et al. The use of online posts to identify barriers to and facilitators of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men: a comparison to a systematic review of the peer-reviewed literature. AIDS Behav. 2018;22(4):1080–95.

    Article  Google Scholar 

  14. Ezennia O, Geter A, Smith DK. The PrEP care continuum and black men who have sex with men: a scoping review of published data on awareness, uptake, adherence, and retention in PrEP care. AIDS Behav. 2019;23(10):2654–73.

    Article  Google Scholar 

  15. Remy L, Enriquez M. Behavioral interventions to enhance PrEP uptake among black men who have sex with men: a review. J Assoc Nurses AIDS Care JANAC. 2019;30(2):151–63.

    Article  Google Scholar 

  16. Sullivan PS, Mena L, Elopre L, Siegler AJ. Implementation strategies to Increase PrEP uptake in the South. Curr HIV/AIDS Rep. 2019;16(4):259–69.

    Article  Google Scholar 

  17. Maxwell S, Gafos M, Shahmanesh M. Pre-exposure prophylaxis use and medication adherence among men who have sex with men: a systematic review of the literature. J Assoc Nurses AIDS Care. 2019;30(4):e38–61.

    Article  Google Scholar 

  18. Kamitani E, Johnson WD, Wichser ME, Adegbite AH, Mullins MM, Sipe TA. Growth in proportion and disparities of HIV PrEP use among key populations identified in the United States national goals: systematic review & meta-analysis of published surveys. JAIDS J Acquir Immune Defic Syndr. 2020;84(4):379–86.

    Article  Google Scholar 

  19. Peng P, Su S, Fairley CK, Chu M, Jiang S, Zhuang X, et al. A global estimate of the acceptability of pre-exposure prophylaxis for HIV among men who have sex with men: a systematic review and meta-analysis. AIDS Behav. 2018;22(4):1063–74.

    Article  Google Scholar 

  20. Zhabokritsky A, Nelson LE, Tharao W, Husbands W, Sa T, Zhang N, et al. Barriers to HIV pre-exposure prophylaxis among African, Caribbean and Black men in Toronto, Canada. PLoS ONE. 2019;14(3):e0213740.

  21. Rana J, Wilton J, Fowler S, Hart TA, Bayoumi AM, Tan DHS. Trends in the awareness, acceptability, and usage of HIV pre-exposure prophylaxis among at-risk men who have sex with men in Toronto. Can J Public Health 2018;109(3):342–52.

  22. Mosley T, Khaketla M, Armstrong HL, Cui Z, Sereda P, Lachowsky NJ, et al. Trends in awareness and use of HIV PrEP among gay, bisexual, and other men who have sex with men in Vancouver, Canada 2012–2016. AIDS Behav. 2018;22(11):3550–65.

    Article  Google Scholar 

  23. Armstrong H, Pan S, Barath J, Olarewaju G, Rodrigues R, Messier-Peet M, et al. P503 Trends in awareness and use of PrEP among HIV-negative men who have sex with men in vancouver, toronto, and montreal. Sex Transm infect. 2019;95(Suppl 1):A231–2.

    Google Scholar 

  24. Lachowsky NJ, Lawson Tattersall T, Sereda P, Wang C, Edwards J, Hull M. 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. Sex Health. 2019;16(2):180–6.

    PubMed  Google Scholar 

  25. Lebouché B, Engler K, Machouf N, Lessard D, Thomas R. Predictors of interest in taking pre-exposure prophylaxis among men who have sex with men who used a rapid HIV-testing site in Montreal (Actuel sur Rue). HIV Med. 2016;17(2):152–8.

    Article  Google Scholar 

  26. Noble M, Jones AM, Bowles K, DiNenno EA, Tregear SJ. HIV testing among internet-using MSM in the United States: systematic review. AIDS Behav. 2017;21(2):561–75.

    Article  Google Scholar 

  27. Brogan N, Paquette D, Lachowsky N, Blais M, Brennan D, Hart T, et al. Experiences and needs of Canadian men-who-have-sex-with-men, 2017 survey results. CCDR. 2019;45:11.

    Article  Google Scholar 

  28. Weatherburn P, Hickson F, Reid DS, Marcus U, Schmidt AJ. European Men-who-have-sex-with-men Internet Survey (EMIS-2017): design and methods. Sexual Res Soc Policy. 2019:17(4):543–557.

  29. Tan DH, Hull MW, Yoong D, Tremblay C, O’Byrne P, Thomas R, et al. Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ. 2017;189(47):E1448–58.

    Article  Google Scholar 

  30. 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. JAIDS J Acquir Immune Defic Syndr. 2012;60(4):421–7.

    Article  Google Scholar 

  31. Akoglu H. User’s guide to correlation coefficients. Turkish J Emerg Med. 2018;18(3):91–3.

    Article  Google Scholar 

  32. Hubach RD, Currin JM, Sanders CA, Durham AR, Kavanaugh KE, Wheeler DL, et al. Barriers to access and adoption of pre-exposure prophylaxis for the prevention of HIV among men who have sex with men (MSM) in a relatively rural state. Aids Educ Prev. 2017;29(4):315–29.

    Article  Google Scholar 

  33. Hammack PL, Meyer IH, Krueger EA, Lightfoot M, Frost DM. HIV testing and pre-exposure prophylaxis (PrEP) use, familiarity, and attitudes among gay and bisexual men in the United States: a national probability sample of three birth cohorts. PLoS ONE. 2018;13(9):e0202806-e.

  34. Canada PHAO. Population-specific HIV/AIDS Status Report: People living with HIV/AIDS: Public Health Agency of Canada; 2013.

  35. Dubov A, Galbo P Jr, Altice FL, Fraenkel L. Stigma and shame experiences by MSM who take PrEP for HIV prevention: a qualitative study. Am J Mens Health. 2018;12(6):1843–54.

    Article  Google Scholar 

  36. Schrimshaw EW, Downing MJ, Cohn DJ. Reasons for non-disclosure of sexual orientation among behaviorally bisexual men: non-disclosure as stigma management. Arch Sex Behav. 2018;47(1):219–33.

    Article  Google Scholar 

  37. Durso LE, Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexual Res Soc Policy. 2013;10(1):35–42.

    Article  Google Scholar 

  38. Hajizadeh M, Edmonds S. Universal pharmacare in Canada: a prescription for equity in healthcare. Int J Health Policy Manag. 2020;9(3):91–5.

    Article  Google Scholar 

  39. Khawcharoenporn T, Mongkolkaewsub S, Naijitra C, Khonphiern W, Apisarnthanarak A, Phanuphak N. HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna. AIDS Res Ther. 2019;16(1):13.

    Article  Google Scholar 

  40. Kwakwa HA, Bessias S, Sturgis D, Walton G, Wahome R, Gaye O, et al. Engaging United States black communities in HIV pre-exposure prophylaxis: analysis of a PrEP engagement cascade. J Natl Med Assoc. 2018;110(5):480–5.

    Article  Google Scholar 

Download references

Acknowledgements

Health Initiative for Men, Rézo, Gay Men’s Sexual Health Alliance of Ontario, CATIE, Ontario HIV Treatment Network, Université du Quebec à Montréal, University of Toronto, University of Windsor, University of Victoria, Public Health Agency of Canada, Rob Gair. EMIS-2017 was undertaken by Sigma Research at the London School of Hygiene and Tropical Medicine (LSHTM) in association with the Robert Koch Institute (RKI) in Berlin. EMIS-2017 core team: Axel J. Schmidt, Ford Hickson, David Reid, and Peter Weatherburn @ LSHTM and Ulrich Marcus @ RKI.

Funding

EMIS-2017 was carried under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. Participation of Canada was funded by the Public Health Agency of Canada. Nathan J Lachowsky is supported by Scholar Award from the Michael Smith Foundation for Health Research (#16863). Trevor Hart holds an Ontario HIV Treatment Network (OHTN) Chair in Gay and Bisexual Men’s Health.

Author information

Authors and Affiliations

  1. Ontario HIV Treatment Network, Toronto, Canada

    Sean Colyer & Abigail E. Kroch

  2. School of Public Health and Social Policy, University of Victoria, Victoria, Canada

    Nathan J. Lachowsky

  3. Community Based Research Centre, Vancouver, Canada

    Nathan J. Lachowsky

  4. Sigma Research, London School of Hygiene and Tropical Medicine, London, UK

    Axel J. Schmidt

  5. Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Canada

    Barry D. Adam

  6. Public Health Agency of Canada, Ottawa, Canada

    Dana Paquette

  7. Department of Psychology, Ryerson University, Toronto, Canada

    Trevor A. Hart

  8. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Trevor A. Hart & Abigail E. Kroch

  9. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada

    David J. Brennan

  10. Département de Sexologie, Université du Québec À Montréal, Montréal, Canada

    Martin Blais

  11. Public Health Ontario, Toronto, Canada

    Abigail E. Kroch

  12. Ontario HIV Treatment Network, 1300 Yonge St, Suite 600, Toronto, ON, M4T 1X3, Canada

    Sean Colyer

Authors
  1. Sean Colyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathan J. Lachowsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Axel J. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barry D. Adam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dana Paquette
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Trevor A. Hart
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David J. Brennan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Blais
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Abigail E. Kroch
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SC, NL, and AEK contributed to the study conception and design. SC performed the data analysis and wrote the first draft of the manuscript. AJS lead on EMIS survey design, promotion, and execution, coordinated translations and the EMIS network, cleaned the data, wrote the variable manual, and extracted the Canadian data. DP coordinated the EMIS study and analysis of EMIS data in Canada. NJL, BDA, TH, DJB, and MB helped inform the promotional efforts in Canada and provided feedback for the EMIS questionnaire. All authors amended the data analysis plan, contributed to the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Sean Colyer.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Research ethics approval was granted by Health Canada and the Public Health Agency of Canada’s Research Ethics Board.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 47 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Colyer, S., Lachowsky, N.J., Schmidt, A.J. et al. Measures of HIV Pre-exposure Prophylaxis Uptake Among Gay, Bisexual, and Other Men Who Have Sex with Men in Canada and Demographic Disparities Among Those at Elevated Likelihood for HIV Acquisition. AIDS Behav 25, 3638–3650 (2021). https://doi.org/10.1007/s10461-021-03336-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03336-3

Keywords

Search

Navigation