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

  • Terrance Mosley
  • Moliehi Khaketla
  • Heather L. Armstrong
  • Zishan Cui
  • Paul Sereda
  • Nathan J. Lachowsky
  • Mark W. Hull
  • Gbolahan Olarewaju
  • Jody Jollimore
  • Joshua Edward
  • Julio S. G. Montaner
  • Robert S. Hogg
  • Eric A. Roth
  • David M. Moore
Original Paper


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.


HIV/AIDS Pre-exposure prophylaxis Men who have sex with men Primary prevention Longitudinal data 


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.



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.


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

Compliance with Ethical Standards

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).

Research Involving Human Participants

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.

Informed Consent

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


  1. 1.
    Public Health Agency of Canada. Summary: Estimates of HIV incidence, prevalence and proportion undiagnosed in Canada, 2014. Accessed 15 Jan 2017.
  2. 2.
    BC Centre for Disease Control. HIV in British Columbia: Annual Surveillance Report 2014. Accessed 15 Jan 2017.
  3. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Heitz D. Insurers and Medicaid cover it. So what’s behind the slow adoption of Truvada PrEP? Healthline News. Accessed 7 Feb 2017.
  8. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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].Google Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 12.
    CDC. Lifetime risk of HIV diagnosis. Atlanta, Georgia. The Centers for Disease Control and Prevention. Accessed 10 Feb 2017.
  13. 13.
    AIDSmap. PrEP use is rising fast in US, but large disparities remain. Accessed 10 Feb 2017.
  14. 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). Accessed 10 Feb 2017.
  15. 15.
    U.S Food & Drug Administration. FDA approves first medication to reduce HIV risk. Consumer updates. Accessed 16 Jan 2017.
  16. 16.
    Health Canada. Regulatory decision summary: TRUVADA. Accessed 16 Jan 2017.
  17. 17.
    CTAC. TxMAP. Non-insured health benefits program. Information on HIV/HCV drugs and eligibility criteria for federal plans. Accessed 11 Feb 2017.
  18. 18.
    British Columbia Centre for Excellence in HIV/AIDS. Drug Treatment Program. Accessed 16 March 2017.
  19. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 23.
    Therapeutic Goods Administration. Prescription medicines: new or extended uses, or new combination of registered medicines. Australian Government, Department of Health. Accessed 15 March 2017.
  24. 24.
    ASHM. PBAC rejects application for HIV PrEP. Accessed 15 March 2017.
  25. 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.CrossRefGoogle Scholar
  26. 26.
    Jollimore J. For health initiative for men. Gilead: Please ask Health Canada to approve Truvada for PrEP. Accessed 7 Feb 2017.
  27. 27.
    Bell N. Want insurance to cover your PrEP? Good Luck. DailyXtra. Accessed 16 March 2017.
  28. 28.
    Ellis E. Insurer stops covering HIV prevention drug. Vancouver Sun. Accessed 16 March 2017.
  29. 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.CrossRefPubMedGoogle Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 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.CrossRefPubMedGoogle Scholar
  33. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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: Accessed 10 Feb 2017.
  41. 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: 2016-05-10-RPT-HealthTwoSpirit-Hunt-EN-Web.pdf. Accessed 10 Feb 2017.
  42. 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.CrossRefPubMedGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 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.CrossRefGoogle Scholar
  46. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 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.CrossRefPubMedGoogle Scholar
  48. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 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.CrossRefPubMedGoogle Scholar
  51. 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.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Terrance Mosley
    • 1
    • 8
  • Moliehi Khaketla
    • 2
  • Heather L. Armstrong
    • 2
    • 3
    • 8
  • Zishan Cui
    • 3
  • Paul Sereda
    • 3
  • Nathan J. Lachowsky
    • 3
    • 4
    • 8
  • Mark W. Hull
    • 2
    • 3
  • Gbolahan Olarewaju
    • 3
    • 8
  • Jody Jollimore
    • 5
  • Joshua Edward
    • 6
  • Julio S. G. Montaner
    • 2
    • 3
  • Robert S. Hogg
    • 3
    • 7
    • 8
  • Eric A. Roth
    • 4
    • 8
  • David M. Moore
    • 2
    • 3
    • 8
  1. 1.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  2. 2.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.BC Centre for Excellence, HIV/AIDSVancouverCanada
  4. 4.University of VictoriaVictoriaCanada
  5. 5.Community-Based Research Centre for Gay Men’s HealthVancouverCanada
  6. 6.Health Initiative for MenVancouverCanada
  7. 7.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  8. 8.The Momentum Health StudyVancouverCanada

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