Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey

Abstract

re-exposure prophylaxis (PrEP) for HIV using tenofovir disoproxil fumarate-emtricitabine is highly effective at reducing the risk of HIV infection 1-3 and has been approved for daily use in Canada since 2016. However, despite a significant increase in the number of PrEP users in the past years, 4,5 it is estimated that far more people could benefit from using PrEP. 6,7 Barriers to PrEP uptake exist at the individual, interpersonal, community and structural level. 8 At the individual level, lack of awareness, perceived lack of efficacy, concern about adverse effects and low HIV risk perception are common. At the interpersonal level, there is fear of risk compensation (increase in risk-taking behaviours as a result of a decrease in perceived risk) and stigma from peers, family and friends. At the community level, barriers include mistrust of the pharmaceutical industry and medical establishment, and inadequate access to health care providers experienced in working with sexual or gender minorities. In addition, providers' lack of awareness or training, lack of referral pathways, concern about risk compensation and concern about patient adherence can be