Community-Based Research Centre for Gay Men's Health, 1007-808 Nelson St., Vancouver, BC, V6Z 2H2, Canada.
University of British Columbia, Vancouver, BC, Canada.
Can J Public Health. 2018 Dec;109(5-6):791-799. doi: 10.17269/s41997-018-0090-1. Epub 2018 Jun 5.
OBJECTIVES: Pre-exposure prophylaxis (PrEP) is a highly effective, HIV prevention strategy increasingly being accessed by gay, bisexual, and other men who have sex with men (GBMSM). GBMSM face structural and individual-level barriers accessing PrEP, including awareness and cost. This paper assesses socio-demographic factors associated with awareness, interest, and willingness to pay for PrEP in a sample of Canadian GBMSM. METHODS: Data were derived from the 2015 Sex Now survey, a cross-sectional, online survey of GBMSM. Respondents were recruited through social media, sex-seeking "apps," and by word of mouth. We used univariable and multivariable logistic regression models to estimate associations between socio-demographic factors and three primary outcomes. RESULTS: Our sample consisted of 7176 HIV-negative Canadian GBMSM. Of respondents, 54.7% were aware of PrEP, 47.4% were interested in PrEP, and 27.9% of PrEP-interested respondents reported they would pay for PrEP out-of-pocket. Awareness and interest varied between provinces, while GBMSM outside urban areas were less likely to be PrEP aware. Bisexual-identified men, and men over 50, were less likely to be aware and interested in PrEP in multivariable models. Only annual income and educational attainment were associated with willingness to pay for PrEP. CONCLUSION: This study identifies important disparities in awareness, interest, and willingness to pay for PrEP. Future interventions and educational efforts should target non-gay-identified and older GBMSM, as well as GBMSM outside urban areas. PrEP implementation may risk further perpetuating existing health inequities based on socio-economic status if PrEP continues to be accessed primarily through private insurance or paid for out-of-pocket.
目的:暴露前预防(PrEP)是一种非常有效的艾滋病毒预防策略,越来越多的男同性恋、双性恋和其他与男性发生性关系的男性(GBMSM)正在使用这种策略。GBMSM 在获得 PrEP 方面面临着结构性和个人层面的障碍,包括意识和费用。本文评估了加拿大 GBMSM 样本中与 PrEP 意识、兴趣和支付意愿相关的社会人口因素。
方法:数据来自 2015 年的“性现在”调查,这是一项针对 GBMSM 的横断面在线调查。受访者通过社交媒体、性寻求“应用程序”和口口相传招募。我们使用单变量和多变量逻辑回归模型来估计社会人口因素与三个主要结果之间的关联。
结果:我们的样本由 7176 名 HIV 阴性的加拿大 GBMSM 组成。在受访者中,54.7%的人知道 PrEP,47.4%的人对 PrEP 感兴趣,27.9%的 PrEP 感兴趣的受访者表示他们愿意自费购买 PrEP。各省之间的知晓率和兴趣度存在差异,而在城市以外地区的 GBMSM 则不太可能了解 PrEP。在多变量模型中,双性恋者和 50 岁以上的男性不太可能了解和对 PrEP 感兴趣。只有年收入和教育程度与支付 PrEP 的意愿有关。
结论:这项研究发现了在 PrEP 的知晓率、兴趣度和支付意愿方面存在重要差异。未来的干预和教育工作应针对非同性恋认同和年龄较大的 GBMSM 以及城市以外地区的 GBMSM。如果 PrEP 继续主要通过私人保险或自费获得,PrEP 的实施可能会进一步加剧基于社会经济地位的现有健康不平等。
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