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Trends in Awareness and Use of HIV PrEP Among Gay, Bisexual, and Other Men who have Sex with Men in Vancouver, Canada 2012–2016

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Abstract

Gay, bisexual, and other men who have sex with men (gbMSM) are at the highest risk for HIV infection in British Columbia (BC). Pre-exposure prophylaxis (PrEP) has been recently licensed but is currently not publicly funded in BC. Using respondent-driven sampling, we recruited a cohort of gbMSM to complete a computer-assisted self-interview with follow-up every 6 months. Stratified by HIV status, we examined trends in awareness of PrEP from 11/2012 to 02/2016 and factors associated with PrEP awareness. 732 participants responded to the PrEP awareness question. Awareness of PrEP among HIV-negative men increased from 18 to 80% (p < 0.0001 for trend); among HIV-positive men, awareness increased from 36 to 77% (p < 0.0001). PrEP awareness was associated with factors related to HIV risk including sero-adaptive strategies and sexual sensation seeking. Eight HIV-negative men reported using PrEP. Low PrEP uptake highlights that PrEP access should be expanded for at-risk gbMSM in BC.

Resumen

Los hombres que tienen relaciones sexuales con hombres (HSH) están en mayor riesgo de contraer la infección por el VIH en Columbia Británica (BC). La profilaxis previa a la exposición (PrEP) fue recientemente licenciada en Canadá pero actualmente no está financiada públicamente en BC. Usando el muestreo conducido por el encuestado, hemos reclutado una cohorte de HSH para completar una auto-entrevista asistida por ordenador con seguimiento cada seis meses. Estratificado por el estatus de VIH, examinamos las tendencias en el conocimiento de la PrEP de julio de 2012 a febrero de 2016 y los factores asociados con la conciencia de la PrEP. 732 participantes respondieron a la pregunta de sensibilización sobre la PrEP. La proporción de hombres seronegativos que conocían la PrEP aumentó de 18% a 80% (p < 0,0001 para la tendencia); entre los hombres VIH positivos, la conciencia aumentó del 36% al 77% (p < 0,0001). 8 hombres VIH-negativos informaron usar PrEP. La conciencia de PrEP se asoció con factores relacionados con el riesgo de VIH, incluyendo estrategias sero-adaptativas y búsqueda de sensaciones. La baja captación de PrEP destaca que el acceso a la PrEP debería ampliarse para los HSH en riesgo en BC.

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References

  1. Public Health Agency of Canada. Summary: Estimates of HIV incidence, prevalence and proportion undiagnosed in Canada, 2014. http://healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/hiv-aids-estimates-2014-vih-sida-estimations/alt/hiv-aids-estimates-2014-vih-sida-estimations-eng.pdf. Accessed 15 Jan 2017.

  2. BC Centre for Disease Control. HIV in British Columbia: Annual Surveillance Report 2014. http://www.bccdc.ca/util/about/annreport/default.htm. Accessed 15 Jan 2017.

  3. Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep. 2011;8(1):62–72.

    Article  Google Scholar 

  4. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  Google Scholar 

  5. Molina JM, Capitant C, Spire B, et al. On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med. 2015;373:2237–46.

    Article  CAS  Google Scholar 

  6. McCormack S, Dunn DT, Desai M, et al. Preexposure 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.

    Article  Google Scholar 

  7. Heitz D. Insurers and Medicaid cover it. So what’s behind the slow adoption of Truvada PrEP? Healthline News. http://www.healthline.com/health-news/hiv-prevention-truvada-prep-covered-by-most-insurers-050814. Accessed 7 Feb 2017.

  8. Krakower DS, Mimiaga MJ, Rosenberger JG, et al. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an internet social networking site. PLoS ONE. 2012;7(3):e33119.

    Article  CAS  Google Scholar 

  9. Delaney KP, Sanchez T, Bowles K, Oraka E, DiNenno E, Sullivan P. Awareness and use of PrEP appear to be increasing among internet samples of US MSM. Conference on Retroviruses and Opportunistic Infections. Boston, 2016 [Abstract 889].

  10. Khanna AS, Schumm P, Schneider JA. Facebook network structure and awareness of preexposure prophylaxis amoung young men who have sex with men. Ann Epidemiol. 2017;27(3):176–80.

    Article  Google Scholar 

  11. Hood JE, Buskin SE, Dombrowski JC, Kern DA, Barash EA, Katzi DA, Golden MR. Dramatic increase in preexposure prophylaxis among MSM in Washington state. AIDS. 2016;30(3):515–9.

    PubMed  Google Scholar 

  12. CDC. Lifetime risk of HIV diagnosis. Atlanta, Georgia. The Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html. Accessed 10 Feb 2017.

  13. AIDSmap. PrEP use is rising fast in US, but large disparities remain. www.aidsmap.com/PrEP-use-is-rising-fast-in-US-but-large-racial-disparities-remain/page/3065545. Accessed 10 Feb 2017.

  14. CDC. Vital Signs: Estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition—United States, 2015. Morbidity and Mortality Weekly Report (MMWR). https://www.cdc.gov/mmwrmpreview/mmwrhtml/mm6446a4.htm?s_cid=mm6446a4_w. Accessed 10 Feb 2017.

  15. U.S Food & Drug Administration. FDA approves first medication to reduce HIV risk. Consumer updates. http://www.fda.gov/forconsumers/consumerupdates/ucm311821.htm. Accessed 16 Jan 2017.

  16. Health Canada. Regulatory decision summary: TRUVADA. https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?lang=en&linkID=RDS00107. Accessed 16 Jan 2017.

  17. CTAC. TxMAP. Non-insured health benefits program. Information on HIV/HCV drugs and eligibility criteria for federal plans. http://www.ctac.ca/uploads/TxMAP_2015/Federal%20plans/TxMAP_Federal_Plans_NIHB.pdf. Accessed 11 Feb 2017.

  18. British Columbia Centre for Excellence in HIV/AIDS. Drug Treatment Program. http://www.cfenet.ubc.ca/drug-treatment-program. Accessed 16 March 2017.

  19. Lachowsky NJ, Lin SY, Hull MW, et al. 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.

    Article  Google Scholar 

  20. Lachowsky NJ, Lal A, Forrest JI, et al. Including online-recruited seeds: a respondent-driven sample of men who have sex with men. J Med Internet Res. 2016;18(3):e51 Eysenbach G, ed.

    Article  Google Scholar 

  21. Kalichman S, Rompa D. Sexual sensation seeking and sexual compulsivity scales: reliability, validity and predicting HIV risk behavior. J Pers Assess. 1995;65(3):586–601.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  23. Therapeutic Goods Administration. Prescription medicines: new or extended uses, or new combination of registered medicines. Australian Government, Department of Health. https://www.tga.gov.au/prescription-medicines-new-or-extended-uses-or-new-combinations-registered-medicines-2016. Accessed 15 March 2017.

  24. ASHM. PBAC rejects application for HIV PrEP. http://www.ashm.org.au/news/pbac-rejects-application-for-hiv-prep/. Accessed 15 March 2017.

  25. Holt M, Lea T, Kippax S, et al. Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey. Sex Health. 2016;13(4):359–65.

    Article  Google Scholar 

  26. Jollimore J. For health initiative for men. Gilead: Please ask Health Canada to approve Truvada for PrEP. http://www.petitions24.com/gilead_please_make_health_canada_application_for_truvada_as_prep. Accessed 7 Feb 2017.

  27. Bell N. Want insurance to cover your PrEP? Good Luck. DailyXtra. http://www.dailyxtra.com/vancouver/news-and-ideas/news/want-insurance-cover-prep-good-luck-185941. Accessed 16 March 2017.

  28. Ellis E. Insurer stops covering HIV prevention drug. Vancouver Sun. http://vancouversun.com/news/local-news/insurer-stops-covering-hiv-prevention-drug. Accessed 16 March 2017.

  29. Klitzman RL, Pope HG, Hudson JI. MDMA (“Ecstasy”) abuse and high-risk sexual behaviors among 169 gay and bisexual men. Am J Psychiatry. 2000;157:1162–4.

    Article  CAS  Google Scholar 

  30. Snowden JM, Wei C, McFarland W, Raymond HF. Prevalence, correlates and trends in seroadaptive behaviours among men who have sex with men from serial cross-sectional surveillance in San Francisco, 2004-2011. Sex Transm Infect. 2014;90:498–504.

    Article  Google Scholar 

  31. Jin F, Jansson J, Law M, et al. Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART. AIDS. 2010;24(6):907–13.

    Article  Google Scholar 

  32. Wolitski RJ, Bailey CJ, O’Leary A, Gómez CA, Parsons JT. Seropositive urban men’s study (SUMS). Self-perceived responsibility of HIV-seropositive men who have sex with men for preventing HIV transmission. AIDS Behav. 2003;7(4):363–72.

    Article  Google Scholar 

  33. Mayer KH, Oldenburg CE, Novak DS, Elsesser SA, Krakower DS, Mimiaga MJ. Early adopters: correlates of HIV chemoprophylaxis use in recent online samples of US men who have sex with men. AIDS Behav. 2016;20(7):1489–98.

    Article  Google Scholar 

  34. Bauermeister JA, Meanley S, Pingel E, Soler JH, Haper GW. PrEP awareness and perceived barriers among single young men who have sex with men in the United States. Curr HIV Res. 2013;11(7):520–7.

    Article  CAS  Google Scholar 

  35. Burch LS, Smith CJ, Anderson J, et al. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. Lancet Public Health. 2016;1(1):e26–36.

    Article  Google Scholar 

  36. Pelloski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013;68(4):197–209.

    Article  Google Scholar 

  37. Cunningham WE, Hays RD, Duan N, et al. The effect of socioeconomic status on the survival of people receiving care for HIV infection in the United States. J Health Care Poor Underserved. 2005;16(4):655–76.

    Article  Google Scholar 

  38. Weiser SD, Bangsberg DR, Kegeles S, Ragland K, Kushel MB, Frongillo EA. Food Insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav. 2009;13(5):841–8.

    Article  Google Scholar 

  39. Weiser SD, Fernandes KA, Brandson EK, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52(3):342–9.

    Article  Google Scholar 

  40. Reading CL, Wien F. Health inequalities and social determinants of Aboriginal peoples’ health. Prince George, BC: National Collaborating Centre for Aboriginal Health. Available at: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/46/health_inequalities_EN_web.pdf. Accessed 10 Feb 2017.

  41. Hunt, S. An introduction to the health of two-spirit people: historical, contemporary and emergent issues. Prince George, BC: National Collaborating Centre for Aboriginal Health. Available at: http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/156/ 2016-05-10-RPT-HealthTwoSpirit-Hunt-EN-Web.pdf. Accessed 10 Feb 2017.

  42. Newman PA, Woodford MR, Logie C. HIV vaccine acceptability and culturally appropriate dissemination among sexually diverse Aboriginal peoples in Canada. Glob Public Health. 2012;7(1):87–100.

    Article  CAS  Google Scholar 

  43. Brotman S. Reclaiming space-regaining health: the health care experiences of two-spirit people in Canada. J Gay Lesbian Soc Serv. 2002;14(1):67–87.

    Article  Google Scholar 

  44. Wilton J, Kain T, Fowler S, et al. 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(1):20777.

    Article  Google Scholar 

  45. Bauermeister JA, Meanley S, Pingel E, Soler JH, Harper GW. PrEP awareness and perceived barriers among single young men who have sex with men in the United States. Curr HIV Res. 2014;11(7):520–7.

    Article  Google Scholar 

  46. Al-Tayyib AA, Thrun MW, Haukoos JS, Walls NE. Knowledge of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men in Denver Colorado. AIDS Behav. 2014;18(S3):340–7.

    Article  Google Scholar 

  47. Leonardi M, Lee E, Tan DH. Awareness of, usage of and willingness to use HIV pre-exposure prophylaxis among men in downtown Toronto, Canada. Int J STD AIDS. 2011;22(12):738–41.

    Article  CAS  Google Scholar 

  48. Knight R, Small W, Carson A, Shoveller J. Complex and conflicting social norms: implications for implementation of future pre-exposure prophylaxis (PrEP) interventions in Vancouver, Canada. PLoS ONE. 2016;11(1):e0146513.

    Article  Google Scholar 

  49. Sharma M, Wilton J, Senn H, Fowler S, Tan DH. Preparing for PrEP: perceptions and readiness of Canadian physicians for the implementation of HIV pre-exposure prophylaxis. PLoS ONE. 2014;9(8):e105283.

    Article  Google Scholar 

  50. Karris MY, Beekmann SE, Mehta SR, Anderson CM, Polgreen PM. Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada. Clin Infect Dis. 2014;58(5):704–12.

    Article  CAS  Google Scholar 

  51. Kesler MA, Kaul R, Liu J, et al. Actual sexual risk and perceived risk of HIV acquisition among HIV-negative men who have sex with men in Toronto, Canada. BMC Public Health. 2016;16:254.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the Momentum Health Study participants, office staff, and community advisory board, as well as our community partner agencies, Health Initiative for Men, YouthCO HIV & Hep C Society, and Positive Living Society of BC. Momentum is funded through the National Institute on Drug Abuse (R01DA031055-01A1) and the Canadian Institutes for Health Research (MOP-107544, 143342, PJT-153139). NJL was supported by a CANFAR/CTN Postdoctoral Fellowship Award. DMM and NJL are supported by Scholar Awards from the Michael Smith Foundation for Health Research (#5209, #16863). HLA is supported by a Postdoctoral Fellowship Award from the Canadian Institutes of Health Research (Grant # MFE-152443). JM is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). He has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.

Funding

Momentum is funded through the National Institute on Drug Abuse (R01DA031055-01A1) and the Canadian Institutes of Health Research (MOP-107544, 143342, PJT-153139).

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Authors and Affiliations

  1. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Terrance Mosley

  2. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Moliehi Khaketla, Heather L. Armstrong, Mark W. Hull, Julio S. G. Montaner & David M. Moore

  3. BC Centre for Excellence, HIV/AIDS, Vancouver, BC, Canada

    Heather L. Armstrong, Zishan Cui, Paul Sereda, Nathan J. Lachowsky, Mark W. Hull, Gbolahan Olarewaju, Julio S. G. Montaner, Robert S. Hogg & David M. Moore

  4. University of Victoria, Victoria, BC, Canada

    Nathan J. Lachowsky & Eric A. Roth

  5. Community-Based Research Centre for Gay Men’s Health, Vancouver, BC, Canada

    Jody Jollimore

  6. Health Initiative for Men, Vancouver, BC, Canada

    Joshua Edward

  7. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Robert S. Hogg

  8. The Momentum Health Study, 505-1200, Burrard St., Vancouver, BC, V6Z 1Z5, Canada

    Terrance Mosley, Heather L. Armstrong, Nathan J. Lachowsky, Gbolahan Olarewaju, Robert S. Hogg, Eric A. Roth & David M. Moore

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  1. Terrance Mosley
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Correspondence to Terrance Mosley.

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Conflict of interest

NJL was supported by a CANFAR/CTN Postdoctoral Fellowship Award. JSGM is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). JSGM has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. DMM and NJL are supported by Scholar Award from the Michael Smith Foundation for Health Research (#5209, #16863). HLA is supported by a Postdoctoral Fellowship Award from the Canadian Institutes of Health Research (Grant # MFE-152443).

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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.

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

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Mosley, T., Khaketla, M., Armstrong, H.L. 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 22, 3550–3565 (2018). https://doi.org/10.1007/s10461-018-2026-4

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