Although PrEP has been publicly available in Brazil since early-2018 and through demonstration projects in Mexico and Peru since mid-2018, little is known about PrEP-related barriers. We examined factors associated with PrEP-related barriers among MSM in these countries.
MSM were recruited in 2018 to complete an online survey. Eligible individuals were cisgender MSM, ≥18 years old, HIV negative or of unknown status, lived in these countries and provided informed consent. The survey asked about 12 PrEP-related concerns on a 5-point Likert scale, which were then categorized into informational, behavioral and belief barriers. Responses by domain were summed to create three continuous outcomes; then, multiple linear regression was conducted for each outcome using Stata 14.
Of the 43,687 participants who started the survey, 19,457 MSM remained for analysis after dropout and application of exclusion criteria. Most respondents were Brazilian (58%), had post-secondary education (60%), reported low to middle income (83%); and their median age was 28 (IQR: 24-34). Overall, concern regarding informational barriers was higher than behavioral or belief barriers (see graph). Respondents with lower informational barriers were: Brazilian(-1.7), aware of PrEP(-0.6), ever taken PrEP(-0.1) and at higher risk of contracting HIV(-0.4); while Peruvians(0.2) had higher informational barriers. Respondents with lower behavioral barriers were: Brazilian(-0.6), aware of PrEP(-1.1), 18-24 years old(-0.4), middle(-0.5) or high income(-1.2), used drugs(-0.7), had a stable male partner(-0.2) and ever tested for HIV(-0.7); whereas Peruvians(0.5) and those without secondary education(0.8) had higher behavioral barriers. Respondents with lower belief barriers were: Brazilian(-0.9), aware of PrEP(-1.5), 18-24 years old(-0.3), middle(-0.4) or higher income(-0.9), had a stable male partner(-0.3) and ever tested for HIV(-0.4). Peruvians(0.4) and those without secondary education(0.6) had higher belief barriers. All regression model coefficients had p-values<0.05.
Informational barriers were the highest of the 3 domains; simultaneously, those most informed (e.g., Brazilians and PrEP aware) had consistently lower barrier scores across all 3 domains. These findings indicate that PrEP barriers are likely amenable to interventions promoting PrEP awareness and education. Such interventions will be needed to reduce PrEP-related barriers, increase its uptake, and reduce HIV incidence in these countries.