PT  - JOURNAL ARTICLE
AU  - Cox, Joseph
AU  - Apelian, Herak
AU  - Moodie, Erica E.M.
AU  - Messier-Peet, Marc
AU  - Hart, Trevor A.
AU  - Grace, Daniel
AU  - Moore, David M.
AU  - Lachowsky, Nathan J.
AU  - Armstrong, Heather L.
AU  - Jollimore, Jody
AU  - Skakoon-Sparling, Shayna
AU  - Rodrigues, Ricky
AU  - Tan, Darrell H.S.
AU  - Maheu-Giroux, Mathieu
AU  - Noor, Syed W.
AU  - Lebouché, Bertrand
AU  - Tremblay, Cecile
AU  - Olarewaju, Gbolahan
AU  - Lambert, Gilles
ED - 
TI  - Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study
AID  - 10.9778/cmajo.20200198
DP  - 2021 Apr 01
TA  - CMAJ Open
PG  - E529--E538
VI  - 9
IP  - 2
4099  - http://www.cmajopen.ca/content/9/2/E529.short
4100  - http://www.cmajopen.ca/content/9/2/E529.full
SO  - CMAJ2021 Apr 01; 9
AB  - Background: In Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Our objective was to describe access to HIV pre-exposure prophylaxis (PrEP) and identify factors associated with not using PrEP among self-reported HIV-negative or HIV-unknown GBM.Methods: This was a cross-sectional analysis of the Engage study cohort. Between 2017 and 2019, sexually active GBM aged 16 years or more in Montréal, Toronto and Vancouver were recruited via respondent-driven sampling (RDS). Participation included testing for HIV and sexually transmitted and blood-borne infections, and completion of a questionnaire. We examined PrEP access using a health care services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those for whom PrEP was clinically recommended and who were aware of the intervention.Results: A total of 2449 GBM were recruited, of whom 2008 were HIV-negative or HIV-unknown; 1159 (511 in Montréal, 247 in Toronto and 401 in Vancouver) met clinical recommendations for PrEP. Of the 1159, 1100 were aware of PrEP (RDS-adjusted proportion: Montréal 84.6%, Toronto 94.2%, Vancouver 92.7%), 678 had felt the need for PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 39.2%, Toronto 56.1%, Vancouver 49.0%), 406 had tried to access PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 20.6%, Toronto 33.2%, Vancouver 29.6%) and 319 had used PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 14.5%, Toronto 21.6%, Vancouver 21.8%). Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider and lacking medication insurance.Interpretation: Although half of GBM met clinical recommendations for PrEP, less than a quarter of them reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health care system barriers is needed to scale up PrEP access among GBM in Canada.