PrEP awareness among men who have sex with men at higher risk for HIV in Brazil, Mexico, and Peru, 2018

Abstract

IntroductionPrEP awareness in Latin America has been poorly characterized, with studies in Brazil, Mexico, and Peru highlighting low awareness. We assessed the association between higher risk of HIV infection, indicative of PrEP eligibility, and PrEP awareness among men who have sex with men (MSM) from these countries. MethodsMSM were recruited to complete an online survey via advertisements on Facebook, Grindr, and Hornet from March-June 2018. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, lived in these countries, and provided informed consent. Higher risk was defined using a CDC score indicating an increased risk of HIV infection and the suggested cutpoint of 10. We used Poisson regression models to calculate adjusted prevalence ratios (aPR) testing the association between higher risk and PrEP awareness; socio-demographics and other risk variables were considered potential confounders. Separate models were conducted for Brazil, Mexico, and Peru. ResultsAfter exclusion, 19,457 MSM were available for analysis. Overall PrEP awareness was 64.9%, with those from Brazil reporting highest awareness (68.8%), followed by Mexico (64.1%), and Peru (46.6%). In Brazil, 53.8% were classified as higher risk for HIV, 51.9% in Mexico, and 54.2% in Peru. Higher risk for HIV was associated with PrEP awareness among those in Brazil (aPR 1.04, 95% CI 1.01, 1.06), but no association was seen in Mexico or Peru. Additionally, having more than high school education, high income, daily use of gay social networking (GSN) applications, and substance use were associated with PrEP awareness in each country. ConclusionHigher risk of HIV infection was associated with increased PrEP awareness in Brazil. However, this association was weak indicating that MSM at higher risk, who would benefit from PrEP, are often not aware of this prevention strategy. In the remaining countries, there was no association between risk and awareness, highlighting a disconnect between need and knowledge. As PrEP is introduced, awareness should increase, as in Brazil where PrEP has been available longer. Interventions to increase PrEP awareness are paramount to increase PrEP uptake and prevent HIV infections. GSN applications and social media could play an important role to achieve this goal.

The HIV epidemic in Latin America

“…Though the endorsement of ‘Treat All’ by all Latin American countries is paramount, the actual impact of such policy, as models have shown [56], will be limited by just how much testing is universally available and performed and how fast treatment can be initiated. On testing, low risk perception has been shown highly discordant to actual risk taking behavior [42,43], which certainly hinders its use. We need to expand the adoption of new testing platforms, such as self-testing in Latin America [2], local studies have shown its feasibility and acceptability [57,58].…”

“…For the population, U = U can lead to decreased HIV transmission by reducing community viral load. Recent studies from the region have shown that the most prevalent reason for never testing for HIV is fear of being HIV infected [43]. Today, we have an opportunity to use testing in a scenario where there are valuable options for both groups, of those who test positive and negative.…”

“…A 2016 online survey conducted using geosocial networking smartphone apps in 10 Brazilian state capitals reported that 58% (2932/5065) were aware of PrEP, willingness to use daily PrEP was reported by 52% (2653/5065) [42]. In another online survey, conducted in Brazil, Mexico and Peru with almost 20 000 participants, PrEP awareness was shown higher in Brazil (69%) and Mexico (64%) than in Peru (47%) [43]. Recent studies also show promising results among TGW with one study from Brazil reporting 76% willingness to use PrEP [44 ▪ ] and another from Argentina reporting 89% (301/337) willingness [45].…”