PrEP has been publicly available in Brazil since early 2018 and through demonstration projects in Mexico and Peru since mid-2018. 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.
MSM were recruited to complete an online survey via advertisements on Facebook, Grindr and Hornet from March-May 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 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. Analyses were conducted in STATA 14.
After exclusion criteria were applied, 19,457 MSM were available for analysis of the 43,687 who began the questionnaire. Median age was 28 (IQR: 24-34), most respondents were Brazilian (58%), had post-secondary education (60%) and reported low to middle income (83%). PrEP awareness was 65%, 4% of respondents had ever used PrEP, and 53% were classified as higher risk. However, only 10% of respondents perceived their HIV risk as high. Among individuals classified as higher risk, 66.8% were aware of PrEP vs. 62.3% of lower risk respondents. The association between higher risk and awareness remained significant (aPR 1.03; 95% CI 1.00, 1.05) after adjustment. Additionally being 25+ years old (vs. 18-24 years), Brazilian, post-secondary education, high income and Gay Social Network (GSN) App use were associated with PrEP awareness. While being Peruvian, having less than secondary education and low income were negatively associated with PrEP awareness (all p-values<0.05).
Higher risk of HIV infection was associated with increased PrEP awareness. However, this association was weak indicating that MSM at higher risk, who would benefit from PrEP, are often not aware of this prevention strategy. As PrEP is introduced, awareness should increase, as seen in Brazil where PrEP has been available longer. Interventions to increase PrEP awareness are paramount, especially among MSM at higher risk, to increase PrEP uptake and prevent HIV infections. Gay Social Network apps and social media could play an important role to achieve this goal.