HIV leadership programming attendance is associated with PrEP and PEP awareness among young, gay, bisexual, and other men who have sex with men in Vancouver, Canada

Abstract

Background Young gay, bisexual, and other men who have sex with men (YGBM) may have reduced engagement and knowledge of HIV care and biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and Treatment as Prevention (TasP), compared with adult GBM. We sought to understand differences in HIV prevention awareness, health care access, and service utilization between youth (16–29 years) and adult (≥30 year) GBM, as well as factors associated with attendance in HIV leadership programming among YGBM living in the publicly funded PrEP setting of Vancouver, Canada. Methods Sexually-active GBM were recruited using respondent-driven sampling (RDS) from February 2012 to February 2015. Participants completed an in-person computer-assisted self-interview every 6 months, up to February 2017, with questions on sociodemographic factors, awareness of biomedical HIV prevention strategies, and an HIV treatment optimism-skepticism scale. Participants were asked if they had ever attended either of two HIV-leadership programs designed for YGBM. Both programs involve multiple GBM-led education and social networking sessions operated by community-based organizations in Vancouver. Multivariable Glimmix confounder models assessed differences between youth and adult GBM. Among younger men, bivariate analyses examined factors associated with HIV-leadership program attendance. Results Of 698 GBM who enrolled in the longitudinal study, 36.8% were less than 30 years old at the first study visit. After controlling for gender identification, sexual orientation, HIV status, and income in the past 6 months, younger GBM ( n = 257/698) had lower awareness of biomedical HIV prevention strategies and less HIV treatment optimism compared with older GBM ( n = 441/698). Among younger GBM who attended HIV-leadership programs ( n = 50), greater awareness of biomedical HIV prevention strategies and higher HIV treatment optimism were reported, compared with non-attendees. Conclusion Younger GBM, who are disproportionately affected by the HIV epidemic, are less aware of new prevention technologies than older GBM, but attending peer-based HIV-leadership programs ameliorates age-disparities in HIV-prevention knowledge and treatment optimism.

Awareness and Use of Post-exposure Prophylaxis for HIV Prevention Among Men Who Have Sex With Men: A Systematic Review and Meta-Analysis

“…The two-phase mixed-method study ( 30 ) included a cross-sectional survey with a self-administered questionnaire and a prospective descriptive study using an in-depth interview, but data needed were collected in the quantitative survey phase. Another study used a longitudinal cohort study to evaluate the impact of HIV leadership programs, and its baseline survey provided the data we needed ( 31 ). All of the remaining quantitative studies were cross-sectional surveys.…”

“…Four studies reported much lower levels of awareness (<40%) among MSM in China ( 33 ); MSM tested in community centers in Portugal ( 38 ) MSM receiving rapid HIV testing in Spain ( 39 ), and among black MSM in the United States ( 13 ). Nine studies reported modest PEP awareness: 41.23% among men engaging in condomless anal sex with men in the United States ( 8 ), 42.5% among MSM in Beijing, China ( 16 ), 46.67% among gay and bisexual men in California ( 40 ), 50% among MSM in Brazil ( 41 ), 56.70% among sexually active MSM in Vancouver, Canada ( 31 ), 57.06% among MSM in Vancouver, Canada ( 42 ), 60.22% among Thai MSM ( 30 ), 60.6% among MSM in four cities of China ( 43 ), and 65.77% among HIV-positive MSM in England ( 44 ). There was significant heterogeneity between studies (Q statistic = 1990.122, I 2 = 99.045; p < 0.001).…”

“…These factors, which could potentially impede or facilitate participant's awareness of PEP, were conceptually divided into different categories within the individual, social (including partners, families, and communities), and structural domains (health systems and legal factors). In the individual domain, low educational attainment, unemployment, having casual partners, and closeted bisexual were negative factors; high-level education, white race/ethnicity, gay sexual identity, knowing the HIV status of one's self, higher personal sexual altruism, metropolitan resident, higher annual Higher number of partners (11) Higher number of partners (39,42) Having casual partners (35) Higher personal sexual altruism (42) Metropolitan resident (8,42) Greater perceived agency to ask sexual partners' HIV status (42) Older age (31,35,37,40) Higher annual income (16,40,43) Having unprotected anal sex (40) Having sex under the influence of a drug (37,40,41) Younger age (16,32) Using Internet as the main way of meeting partners (39) Social factors Interaction with gay culture (39) Internet and community of MSM (33) Lower levels of HIV stigma (16,32) HIV leadership programming (31) Structural factors Disclosure of one's sexual orientation to general practitioner (11) Greater access to condoms (42) Previous HIV testing (11,15,32,38,43) Previous sexually transmitted infection (STI) diagnosis (38,42) Contact with HIV/AIDS organization…”

“…How age, drug use, and number of partners exert influence on awareness of PEP is uncertain. Social factors associated with greater awareness among MSM included more interaction with gay culture (39), lower levels of HIV stigma (32), and HIV leadership programming attendance (31). One study conducted logistic regressions predicting awareness of PEP and found that location was the only significant predictor: compared to Puerto Rican participants, those in Pittsburgh were 5.7 times more likely to have heard of PEP, and those in Boston were 10.1 times more likely to have heard of PEP (8).…”

Knowledge of HIV pre-exposure prophylaxis among immigrant Asian gay men living in New Zealand

“…25 Engaging young and marginalised populations in health care, including HIV care and prevention, is acknowledged as difficult. 16,26,27 We also know that in New Zealand, disclosure of sexuality and sexual practices is difficult for many gay and bisexual men. [28][29][30] Given these difficulties, health-care environments must be carefully planned to ensure appropriate delivery of services.…”