Canadian Journal of Public Health

, Volume 109, Issue 5–6, pp 791–799 | Cite as

Awareness of, interest in, and willingness to pay for HIV pre-exposure prophylaxis among Canadian gay, bisexual, and other men who have sex with men

  • Jeffrey Morgan
  • Olivier Ferlatte
  • Travis Salway
  • James Wilton
  • Mark Hull
Quantitative Research



Pre-exposure prophylaxis (PrEP) is a highly effective, HIV prevention strategy increasingly being accessed by gay, bisexual, and other men who have sex with men (GBMSM). GBMSM face structural and individual-level barriers accessing PrEP, including awareness and cost. This paper assesses socio-demographic factors associated with awareness, interest, and willingness to pay for PrEP in a sample of Canadian GBMSM.


Data were derived from the 2015 Sex Now survey, a cross-sectional, online survey of GBMSM. Respondents were recruited through social media, sex-seeking “apps,” and by word of mouth. We used univariable and multivariable logistic regression models to estimate associations between socio-demographic factors and three primary outcomes.


Our sample consisted of 7176 HIV-negative Canadian GBMSM. Of respondents, 54.7% were aware of PrEP, 47.4% were interested in PrEP, and 27.9% of PrEP-interested respondents reported they would pay for PrEP out-of-pocket. Awareness and interest varied between provinces, while GBMSM outside urban areas were less likely to be PrEP aware. Bisexual-identified men, and men over 50, were less likely to be aware and interested in PrEP in multivariable models. Only annual income and educational attainment were associated with willingness to pay for PrEP.


This study identifies important disparities in awareness, interest, and willingness to pay for PrEP. Future interventions and educational efforts should target non-gay-identified and older GBMSM, as well as GBMSM outside urban areas. PrEP implementation may risk further perpetuating existing health inequities based on socio-economic status if PrEP continues to be accessed primarily through private insurance or paid for out-of-pocket.


Pre-exposure prophylaxis (PrEP) Human immunodeficiency virus (HIV) Canada Men who have sex with men 



La prophylaxie préexposition (PrEP) est. une stratégie de prévention du VIH très efficace, de plus en plus utilisée par les hommes gais et bisexuels et les hommes ayant des relations sexuelles avec d’autres hommes (GBHARSAH). Par contre, les GBHARSAH sont confrontés à des obstacles structurels et individuels face à l’accès à la PrEP, y compris la connaissance de la PrEP et les coûts. Cet article évalue les facteurs sociodémographiques associés à la connaissance, l’intérêt et la volonté de payer pour la PrEP dans un échantillon de GBHARSAH canadiens.


Les données proviennent de l’enquête Sexe au présent 2015, un sondage en ligne de GBHARSAH. Les répondants ont été recrutés par le biais des médias sociaux, des applications de rencontre et du bouche-à-oreille. Nous avons utilisé des modèles de régression logistique univariée et multivariée pour mesurer les associations entre les facteurs sociodémographiques et les trois principales variables de résultats.


Notre échantillon comprenait 7176 GBHARSAH canadiens séronégatifs. En tout, 54,7% des répondants étaient au courant de la PrEP, 47,4% des répondants étaient intéressés par la PrEP, et 27,9% des répondants intéressés par la PrEP ont indiqué qu’ils seraient prêts à payer pour la PrEP. La connaissance et l’intérêt envers la PrEP variaient d’une province à l’autre, tandis que les GBHARSAH en dehors des zones urbaines étaient moins susceptibles de connaitre la PrEP. Les hommes bisexuels et les hommes de plus de 50 ans étaient moins susceptibles de connaître et d’être intéressés par la PrEP dans les modèles multivariés. Seul le revenu annuel et le niveau de scolarité étaient associés à la volonté de payer pour la PrEP.


Cette étude a identifié des disparités importantes dans la connaissance, l’intérêt et la volonté de payer pour la PrEP. Les interventions et les efforts d’éducation devraient cibler les GBHARSAH qui ne s’identifient pas comme gai, les GBHARSAH plus âgés, ainsi que les GBHARSAH en dehors des zones urbaines. De plus, la mise en œuvre de la PrEP risque de perpétuer davantage les inégalités existantes en matière de santé en fonction du statut socioéconomique si la PrEP continue d’être accessible principalement par le biais d’une assurance privée ou si les GBHARSAH doivent payer pour celle-ci.


Prophylaxie préexposition (PrEP) Virus de l’immunodéficience humaine (VIH) Canada Hommes ayant des relations sexuelles avec d’autres hommes 



The authors wish to thank all the respondents who participated in the 2015 Sex Now survey; Rick Marchand and Terry Trussler for their mentorship; and the Investigaytors other staff and volunteers of the Community-Based Research Centre for Gay Men’s Health who helped with survey design and recruitment.

Funding information

The 2015 Sex Now survey was funded by the Vancouver Foundation. The opinions, results, and conclusions are those of the authors and no endorsement by the Ontario HIV Treatment Network or its funder is intended or should be inferred.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  1. 1.Community-Based Research Centre for Gay Men’s HealthVancouverCanada
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.British Columbia Centre for Disease ControlVancouverCanada
  4. 4.Ontario HIV Treatment NetworkTorontoCanada
  5. 5.British Columbia Centre for Excellence in HIV/AIDSVancouverCanada

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