Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 21, 2019
Open Peer Review Period: Feb 22, 2019 - Feb 28, 2019
Date Accepted: May 16, 2019
(closed for review but you can still tweet)
Awareness and factors associated with willingness to use Pre-exposure prophylaxis (PrEP) in Brazil, Mexico and Peru: an online survey among men who have sex with men (MSM)
ABSTRACT
Background:
Pre-exposure prophylaxis (PrEP) with daily oral emtricitabine/tenofovir is being implemented in the context of combined HIV prevention in different settings. Reports on PrEP awareness, willingness to use, and acceptability among MSM have started to emerge over the last few years. Previously reported factors associated with willingness include: awareness, costs, low perception of HIV acquisition risk, higher sexual risk, prior sexually transmitted infection (STI), and unwillingness to use condoms.
Objective:
This study aims to evaluate awareness of PrEP and the factors associated with willingness to use daily oral PrEP (PrEP willingness) among men who have sex with men (MSM) in three Latin American, middle-income countries (Brazil, Mexico and Peru).
Methods:
This online cross-sectional survey was advertised in two gay social networks apps (Grindr and Hornet) used by MSM to find sexual partners and on Facebook during two months in 2018. Inclusion criteria were ≥18 years of age, cisgender men and HIV-negative by self-report. Eligible individuals answered questions on: demographics, behavior, and PrEP (awareness, willingness, barriers and facilitators). Multivariable logistic regression modeling was performed to assess the factors associated with PrEP willingness in each country.
Results:
A total of 19,457 MSM completed the online survey (Brazil: 58%, Mexico: 31%, Peru: 11%); median age was 28 years (IQR: 24-34), almost half lived in large urban cities and 89% were sexually attracted only to men. The majority of the participants were recruited on Grindr (69%). Almost 20% had never tested for HIV and condomless receptive anal sex was reported by 46%. A total of 13,110 (67%) met the ImPrEP demonstration study’s risk-related inclusion criteria (based on WHO criteria for PrEP). PrEP awareness was reported by 65%, this was lower in Peru (46%). Overall, PrEP willingness was reported by 64%, highest in Mexico (70%) and lowest in Peru (58%). In multivariate regression models conducted by country and adjusted for age, schooling, and income: PrEP awareness and an increase of PrEP facilitators were associated with a greater PrEP willingness, while increased behavioral and belief-related barriers were associated with decreased PrEP willingness in all countries.
Conclusions:
In this first cross-country online survey in Latin America willingness to use PrEP was found to be high and directly related to levels of PrEP awareness. Interventions to increase awareness and PrEP knowledge about safety and efficacy are crucial to increase PrEP demand. This study provides important information to support the implementation of PrEP in Brazil, Mexico and Peru.
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.