JMIR Publications

ABSTRACT

Background:

In response to the high cost of HIV pre-exposure prophylaxis (PrEP) medications in Canada, community organizations have created internet-based guides detailing how to legally order generic medications online and travel to collect them in the United States. Little is known about the patients following these guides.

Objective:

Our primary objective was to measure the proportion of gay, bisexual, and other men who have sex with men (gbMSM) living in Ontario and accessing these online guides who intended to use the border-crossing approach. Our secondary objectives were to explore their demographic characteristics, their completion of the steps in the border-crossing approach, and the barriers they perceived.

Methods:

Between 20/07/2017-18/05/2018 we administered two online surveys of gbMSM accessing an online border-crossing guide posted by a gay men’s health organization in Ontario. Participants completed an open baseline survey posted on the border-crossing-guide webpage, and a follow-up survey three months later. Data were analyzed using descriptive statistics. We used multivariable logistic regression to identify characteristics associated with intention to use the border-crossing approach.

Results:

Most of the 141 participants were young (median age 23; IQR 22, 25), Black (82%) gbMSM who had completed a college or undergraduate degree (62%). 20% reported a total family income <$30,000 CAD, another 54% reported <$60,000 CAD, and 55% paid for medications entirely out of pocket. Most participants indicated that they were likely to complete a border-crossing approach (80% at baseline, 79% at follow-up). Characteristics associated with intention to use the approach included being Black (aOR=5.73, 95%CI=2.06,16.61), paying for medications out of pocket (aOR=5.18, 95%CI=1.82,17.04) and having a provider who was thought to be willing to prescribe PrEP (aOR=4.42, 95%CI=1.63,12.41). At baseline and follow-up respectively for the 110 participants who completed both surveys, 65% and 80% had discussed PrEP with a healthcare provider, 18% and 25% had obtained a PrEP prescription, 8% and 5% had ordered medications to that mailbox, while 1% and 0% had crossed the border to collect them. Reported barriers included concerns about the approach’s legality (56%), the security of personal health information (39%), and the safety of online vendors (38%).

Conclusions:

Despite high interest in pursuing an online border-crossing approach to get PrEP medications, such an approach may not be a viable option for PrEP scale-up among interested gbMSM due to logistical challenges and perceptions of safety and legitimacy.