Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention

Abstract

Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.

HIV Treatment Cascades that Leak: Correlates of Drop-off from the HIV Care Continuum among Men who have Sex with Men Worldwide

“…In a previous study, we found that homophobia (perceptions of societal stigma associated with homosexuality), disclosure of sexual identity ("outness"), and service provider stigma were significantly associated with reduced access to HIV services. Conversely, we found that engagement in the local gay community and comfort with service providers were associated with increased access to services [22].…”

“…The methods of the parent study, are published in detail elsewhere [22]. In summary, 6095 participants were recruited from 145 countries via networks of MSM community-based organizations and MSM online websites and list servs.…”

HIV incidence among gay men and other men who have sex with men in 2020: where is the epidemic heading?

“…74 Further potentiating the biological drivers of HIV acquisition and transmission in all settings are the multiple forms of stigma affecting MSM that limit the provision and uptake of HIV prevention, treatment, and care services. [77][78][79] Exposure to stigma including culturally insensitive health workers can result in MSM avoiding HIV testing and other prevention services, limiting diagnosis and awareness of status. 78,[80][81][82] Even more acute, men who are aware of living with HIV may avoid HIV treatment altogether.…”

“…[77][78][79] Exposure to stigma including culturally insensitive health workers can result in MSM avoiding HIV testing and other prevention services, limiting diagnosis and awareness of status. 78,[80][81][82] Even more acute, men who are aware of living with HIV may avoid HIV treatment altogether. 83 Reduced utilisation of health and HIV services by MSM, due to enacted or perceived discrimination, limits knowledge of the risks of condomless anal intercourse and opportunities for access to prevention services.…”

The Current Status of PrEP in Key Populations

“…Among studies focusing on low-income and middle-income countries, MSM participants from South Africa, Uganda, Brazil, Peru, China, India, Kenya, Malaysia, Myanmar, Thailand and Vietnam were surveyed ( [14][15]). In most studies, awareness of PrEP was quite low and the average was 30%.…”