A new study shows most of gay, bi, men who have sex with men (MSM) and other MSM, are aware of PrEP (pre-exposure prophylaxis) – an HIV prevention drug recently made available at no charge to British Columbians at risk of HIV.
Dr. Nate Lachowsky is one of the authors of the study, an Assistant Professor in the School of Public Health and Social Policy at the University of Victoria and Investigator with the Momentum Health Study, a program of the BC Centre for Excellence in HIV/AIDS.
How much did PrEP awareness change over the time you did the study?
We asked gay, bisexual, men who have sex with men (MSM) and other MSM if they were aware of PrEP over the period of late 2012 to early 2016. Only 1 in 4 were aware of PrEP at the start of the study. HIV-negative individuals increased their awareness of PrEP from 18% to 80%. People living with HIV increased their awareness from 36% to 77%. Overall, by the end of the study period 4 of 5 gay, bi, MSM and other MSM in Vancouver were aware of PrEP.
What factors affected awareness level?
Our research identified a number of factors associated with greater awareness of PrEP. People who had more income and more formal education were more likely to be aware. This highlights the need to ensure that our outreach and education efforts overcome social inequities.
We also found that those who reported condomless anal sex with partners with different HIV statuses were more likely to be aware, demonstrating that our health promotion to date has reached some of the right people. This group could benefit from access to PrEP.
Finally, we found people aware of the effectiveness of HIV medications in reducing the viral load of those living with HIV tended to be more aware of PrEP. They are educated about newer biomedical prevention strategies and may find other ways to prevent passing HIV between sexual partners – such as consistent condom use – to be acceptable and effective.
Who was most likely to access PrEP?
PrEP was not freely available in BC until January 2018, limiting access for those who were aware of it and may have benefited from using it as a prevention method. Our study found that only 2% of people (1 in 50) used PrEP. With publicly funded access for those who are most at risk of HIV infection, our goal is to ensure those who need it can access PrEP.
How do you expect PrEP uptake to go with the availability of PrEP?
Among the few people who were using PrEP, all reported objective risks for acquiring HIV. Given the disparity in 2016 between high awareness of PrEP and very low use of PrEP, we expect the number of people accessing PrEP to increase with the new provincial program. For some individuals, PrEP may not be of interest or may not make sense to use. However, we need to ensure conversations about PrEP are happening between gay, bi, MSM and other MSM and their healthcare providers.
As of 2016 when these data were analyzed, there was still a proportion of the population (approximately 1 in 5) not aware of PrEP. Why is that and who are they?
We need to continue to educate people about PrEP, clarify misconceptions about what it is and how it works. We found sub-groups within the gay, bi, MSM and other MSM communities in Vancouver, including Aboriginal, Latino, single and bisexual men were less aware of PrEP. We need to reach the diverse communities of gay, bi, and queer men in Metro Vancouver and British Columbia.
Even with the availability of PrEP, what factors might affect the likelihood of gay, bi, MSM and other MSM to access the treatment?
People who have HIV do not always see themselves as being at risk beforehand. PrEP is an important conversation for all individuals to have with their healthcare providers, including family doctors or sexual health clinic staff.
Many people may not have access to a doctor or are unable to tell their doctor that they have sex with other men. Our healthcare system and services must evolve to ensure we provide all British Columbians with the opportunity to learn about, consider, and access PrEP.