Lachowsky Nathan J, Lawson Tattersall Tessa, Sereda Paul, Wang Clara, Edwards Joshua, Hull Mark
British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; and School of Public Health & Social Policy, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada; and Corresponding author. Email:
School of Public Health & Social Policy, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
Sex Health. 2019 Apr;16(2):180-186. doi: 10.1071/SH18115.
Background HIV rates are persistently disproportionate among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, now publicly funded in British Columbia. This study assessed PrEP-related attitudes, sexual behaviour and self-reported use before public funding.
Adult MSM were recruited from January to June 2017 through a local community-based organisation's PrEP campaign website (www.getpreped.ca). Participants self-completed an anonymous online questionnaire, and were stratified into three groups: (i) HIV-positive participants; (ii) HIV-negative participants not using PrEP; and (iii) HIV-negative participants using PrEP. Descriptive, bivariate and univariate regression analyses were conducted.
Of 249 participants, 191 (77%) were HIV-negative not using PrEP, 41 (17%) were HIV-negative using PrEP and 17 (7%) were HIV-positive. Among PrEP users, 90% used PrEP daily and all reported having recommended medical follow-up care. Among HIV-negative, non-PrEP-users, 44% said they would reduce condom use if they used PrEP and 28% were uncomfortable asking their doctor for PrEP. Interest in PrEP among non-users was associated with higher objective risk scores (i.e. HIV Incidence Risk Index for MSM), higher self-perceived risk, greater perceived PrEP effectiveness, no prescription medications insurance, open or single relationship status (vs closed) and not always using condoms (vs always). Among HIV-positive participants, 53% agreed PrEP reduced stigma for people living with HIV. All study groups perceived a greater percentage of MSM on PrEP (10%, 15%, 18%) than in their own social networks (5%, 4%, 6%).
PrEP health promotion must consider comprehensive PrEP education; accuracy of self-perceived HIV risk and PrEP social norms; and barriers to culturally safe primary care for MSM.
背景 男男性行为者（MSM）中的艾滋病毒感染率一直存在不成比例的情况。暴露前预防（PrEP）是一种有效的艾滋病毒预防方法，目前在不列颠哥伦比亚省由公共资金资助。本研究评估了在公共资金资助之前与PrEP相关的态度、性行为和自我报告的使用情况。
2017年1月至6月，通过当地一个基于社区组织的PrEP宣传活动网站（www.getpreped.ca）招募成年男男性行为者。参与者自行完成一份匿名在线问卷，并被分为三组：（i）艾滋病毒阳性参与者；（ii）未使用PrEP的艾滋病毒阴性参与者；（iii）使用PrEP的艾滋病毒阴性参与者。进行了描述性、双变量和单变量回归分析。
在249名参与者中，191名（77%）为未使用PrEP的艾滋病毒阴性者，41名（17%）为使用PrEP的艾滋病毒阴性者，17名（7%）为艾滋病毒阳性者。在PrEP使用者中，90%每天使用PrEP，且所有人都报告接受了推荐的医疗随访。在未使用PrEP的艾滋病毒阴性者中，44%表示如果使用PrEP他们会减少使用避孕套，28%在向医生咨询PrEP时感到不舒服。未使用者对PrEP的兴趣与更高的客观风险评分（即男男性行为者的艾滋病毒感染风险指数）、更高的自我感知风险、更高的PrEP有效性感知、没有处方药保险、开放或单身关系状态（与封闭状态相比）以及并非总是使用避孕套（与总是使用相比）有关。在艾滋病毒阳性参与者中，53%同意PrEP减少了艾滋病毒感染者的耻辱感。所有研究组认为使用PrEP的男男性行为者比例（10%、15%、18%）高于其自身社交网络中的比例（5%、4%、6%）。
PrEP健康促进必须考虑全面的PrEP教育；自我感知的艾滋病毒风险和PrEP社会规范的准确性；以及男男性行为者获得文化安全初级保健的障碍。
