The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America

Abstract

In Latin America, men who have sex with men (MSM) remain disproportionately impacted by HIV. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool and has been FDA approved in the United States since 2012, but no Latin American state, with the recent exception of Brazil, has implemented PrEP guidelines. We carried out a multinational online survey of MSM in Latin America (n = 22698) in 2012 to assess whether MSM at highest risk of HIV acquisition (i.e., those engaging in condomless anal sex [CAS; n = 2606] and transactional sex [n = 1488]) had higher levels of awareness of PrEP, PrEP use and interest in participating in a PrEP trial. After adjusting for demographic and psychosocial characteristics including depressive symptoms, hazardous alcohol use, childhood sexual abuse, and sexual compulsivity, transactional sex and CAS were associated with increased PrEP awareness (aOR = 1.29, 95% CI: 1.05–1.59, p < .001 and aOR = 1.22, 95% CI: 1.11–1.34, p < .001, respectively) and PrEP trial interest (aOR = 1.45, 95% CI: 1.25–1.71, p < .001 and aOR = 1.74, 95% CI: 1.57–1.95, p < .001, respectively). Findings demonstrate substantial awareness of and interest in PrEP among MSM with behavioral risk factors for HIV in Latin America, suggesting that this region is primed for PrEP implementation, which has been slow.

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

“…"), much of the research on PrEP's implementation has been based on samples from the Global North. There are certainly some notable studies on PrEP from the Global South (Edeza et al, 2019;Hoagland et al, 2017;To & Lee, 2018;Wheelock et al, 2013), though, and we expect this body of research to become more robust in the coming years, especially as PrEP rollout continues in the Caribbean and Latin America (Galea et al, 2018). And, as more individuals adopt PrEP, the pool of potential research participants for PrEP research will expand.…”

Are men who have sex with men at higher risk for HIV in Latin America more aware of PrEP?

“…This study was conducted prior to PrEP being proven efficacious and WHO's 2014 PrEP recommendation [31]. PrEP awareness in Latin America was assessed in 2012 among residents in Brazil, Mexico, and Colombia; survey results showed overall PrEP awareness of 10.4% among MSM mostly of high education and of middle to high income [32].…”

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

“…This association highlights that those of higher education or higher income may be receiving or have access to information about PrEP, but those of lower education or lower income may not. This is of concern because those of lower income may have less access to health services compared to those who are of higher income (34). Further, risk for HIV among those of lower income may be as high or higher compared to those of higher income.…”

“…Prior studies in Peru that assessed PrEP awareness and knowledge took place from 2008 to 2011 (23,(31)(32)(33), preceding being proven efficacious and WHO's 2014 PrEP recommendation. PrEP awareness in Latin America was assessed in 2012 among residents in Brazil, Mexico, and Colombia; survey results showed overall 10.4% of the study population were aware of PrEP (34). However, most participants had a college education and were of middle to high income.…”

“…However, most participants had a college education and were of middle to high income. Thus, the sample may not be representative of those who may have less access to care and thus less awareness of PrEP (34).…”