Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada

Abstract

Pre-exposure prophylaxis (PrEP) reduces HIV acquisition. Our goal was to determine the willingness of men who have sex with men (MSM) to take PrEP given perceived and actual HIV risk. HIV-negative MSM were recruited from September 2010 to June 2012 and asked about PrEP willingness and perceived HIV risk. Actual sexual HIV risk was measured by three condom-use components generated through principal components analysis. General HIV risk was measured using the HIV Incidence Risk Index for MSM (HIRI-MSM). Model 1 measured PrEP willingness given perceived and actual sexual HIV risk. Model 2 included actual HIV sexual risk, perceived HIV risk and general HIV risk. Model 3 removed actual sexual HIV risk. We recruited 150 HIV-negative MSM. About 55% were willing to take PrEP. Reasons for PrEP unwillingness were: low perceived risk (64%), side-effect concerns (44%), daily pill burden (16%) and efficacy concerns (4%). Model 1: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 27.11, 95% CI 1.33-554.43) after adjusting for perceived risk, which was not significantly associated with PrEP willingness (OR 4.79, 95% CI 0.72-31.96). Model 2: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 29.85, 95% CI 1.39-640.53) after adjusting for perceived and general HIV risk, neither of which was significantly associated with PrEP willingness (OR 5.07, 95% CI 0.73-35.09) and (OR 1.58, 95% CI 0.37-6.79), respectively. Model 3: After removing actual sexual HIV risk, MSM with high compared to low perceived risk were more willing to use PrEP (OR 6.85, 95% CI 1.23-38.05), and the HIRI-MSM general risk index was not associated with PrEP willingness (OR 1.87, 95% CI 0.54-6.54). Therefore, actual sexual HIV risk was the best predictor of PrEP willingness and general HIV risk did not inform PrEP willingness.

A systematic review of adherence to oral pre-exposure prophylaxis for HIV – how can we improve uptake and adherence?

“…Many studies report challenges aligning perceived risk with actual risk [ 13 , 14 , 32 – 34 ]. Participants described concern regarding perceived long term side effects in two studies [ 32 , 33 ] and poor adherence was partly attributed to dosing regimen in five studies [ 32 , 33 , 35 – 37 ]. However, a recent study of MSM in Toronto found that high versus low actual HIV risk were more willing to take PrEP (OR 27.11; 95% CI, 1.33 to 554.43) [ 33 ].…”

Awareness and willingness to use HIV pre‐exposure prophylaxis among men who have sex with men in low‐ and middle‐income countries: a systematic review and meta‐analysis

“…More recently, in Europe, proportions of MSM willing to use PrEP have ranged from 47.8% to 54.3% in Scotland [58,59], 57.0% in Portugal [60] and 57.6 % in Spain [61]. Recent Canadian studies reported willingness to use PrEP of 55.0% [62,63]. In the US where the majority of studies on PrEP have been conducted, willingness to use PrEP has ranged from 46.1% to 71.0% [64][65][66][67][68][69].…”

Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining

“…Another barrier is that some persons with HIV risk factors do not feel sufficiently at-risk for HIV to warrant PrEP [5][6][7][8], which relates to perceptions of risk not health systems issues. Studies comparing perceptions of HIV risk against HIV risk scores showed differences in how personal risk-taking was viewed, with many believing their behaviours were "too low-risk" to warrant PrEP [9][10][11][12][13][14][15][16]. While most persons at risk for HIV agreed PrEP was important, many felt this intervention was only necessary for other higher-risk persons, not themselves [17,18].…”