Table 2:
Factors associated with not using pre-exposure prophylaxis among self-reported HIV-negative or unknown participants for whom pre-exposure prophylaxis was clinically recommended and who were aware of pre-exposure prophylaxis
| Factor† | Univariable analysis, OR (95% CI)* n = 1032–1100 |
Multivariable analysis, adjusted OR (95% CI)* n = 987 |
|---|---|---|
| Sociodemographic characteristics | ||
| Age, yr | ||
| ≥ 30 | Reference | Reference |
| < 30 | 2.10 (1.56–2.82) | 1.13 (0.74–1.74) |
| Education | ||
| More than high school | Reference | Reference |
| High school or less | 1.83 (1.08–3.34) | 1.35 (0.64–3.00) |
| Income, $ | ||
| ≥ 30 000 | Reference | Reference |
| < 30 000 | 1.62 (1.21–2.18) | 1.02 (0.65–1.58) |
| In a relationship with a main partner | ||
| No | Reference | Reference |
| Yes | 2.20 (1.63–2.97) | 1.85 (1.21–2.86) |
| Prevention strategies related to sexual behaviour | ||
| Viral load sorting as HIV prevention strategy | ||
| Yes | Reference | Reference |
| No | 3.12 (2.22–4.38) | 1.51 (0.93–2.46) |
| Dimensions related to perceiving need for care | ||
| Perceived risk of HIV infection | ||
| “I don’t feel that I am at high enough risk to use PrEP” | ||
| Strongly disagree/disagree/neutral | Reference | Reference |
| Agree/strongly agree | 7.88 (5.13–12.69) | 6.20 (3.61–11.10) |
| “HIV/AIDS is a less serious threat than it used to be because of new treatments” | ||
| Strongly agree/agree | Reference | Reference |
| Disagree/strongly disagree | 1.91 (1.39–2.63) | 1.42 (0.89–2.27) |
| Knowledge about pre-exposure prophylaxis | ||
| “I know enough about PrEP to tell if it’s right for me or not” | ||
| Strongly agree/agree/neutral | Reference | Reference |
| Disagree/strongly disagree | 2.70 (1.82–4.12) | 2.33 (1.37–4.05) |
| Perceived effectiveness of PrEP at preventing HIV infection | ||
| Completely/very | Reference | Reference |
| Moderately/a little/not at all/no opinion | 8.44 (5.34–14.12) | 3.97 (2.23–7.38) |
| “New drug therapies make people less infectious with HIV” | ||
| Strongly agree/agree | Reference | Reference |
| Disagree/strongly disagree | 2.52 (1.70–3.86) | 1.34 (0.75–2.42) |
| Dimensions related to seeking care | ||
| Impact of pre-exposure prophylaxis use on sexual behaviour | ||
| “I will choose my sexual partners based on whether they are taking PrEP or not” | ||
| Strongly agree/agree/neutral | Reference | Reference |
| Disagree/strongly disagree | 1.48 (1.10–1.98) | 1.56 (1.02–2.41) |
| “If I was taking PrEP, I would most likely stop using condoms” | ||
| Strongly agree/agree/neutral | Reference | Reference |
| Disagree/strongly disagree | 2.69 (1.94–3.78) | 1.99 (1.27–3.14) |
| “I am afraid that guys being on PrEP will stop using other ways of protecting themselves” | ||
| Strongly disagree/disagree/neutral | Reference | Reference |
| Agree/strongly agree | 1.93 (1.40–2.65) | 1.00 (0.63–1.59) |
| Dimensions related to accessing and paying for care | ||
| Access to health care services | ||
| Told primary health care provider about male partners | ||
| Yes | Reference | Reference |
| No | 5.68 (3.38–10.14) | 3.30 (1.68–6.76) |
| No primary care provider | 3.65 (2.62–5.13) | 2.66 (1.65–4.35) |
| Has medication insurance | ||
| Yes | Reference | Reference |
| No | 3.21 (2.26–4.65) | 3.10 (1.91–5.12) |
| “I don’t think I can find a doctor that is sensitive and accepting enough of my sexual activities and choices to prescribe PrEP” | ||
| Strongly disagree/disagree/neutral | Reference | Reference |
| Agree/strongly agree | 7.27 (3.27–20.57) | 5.22 (2.00–16.64) |
| “I know where to go to get a prescription for PrEP” | ||
| Strongly agree/agree/neutral | Reference | Reference |
| Disagree/strongly disagree | 4.13 (2.84–6.19) | 1.63 (0.97–2.76) |
| “I have not sought a prescription for PrEP in the past because of the cost of the medication” | ||
| Strongly disagree/disagree/neutral | Reference | Reference |
| Agree/strongly agree | 1.43 (1.06–1.94) | 1.55 (1.00–2.41) |
| Dimensions related to engaging in care | ||
| Implications of ongoing use of pre-exposure prophylaxis | ||
| “I am worried about the short- and long-term side effects of taking PrEP” | ||
| Strongly disagree/disagree/neutral | Reference | Reference |
| Agree/strongly agree | 2.19 (1.63–2.94) | 1.81 (1.18–2.79) |
| “I don’t like the idea of being required to go to the regular medical follow-up visits involved in taking PrEP” | ||
| Strongly disagree/disagree/neutral | Reference | Reference |
| Agree/strongly agree | 3.03 (1.94–4.94) | 1.23 (0.67–2.31) |
| City and year of recruitment | ||
| City | ||
| Vancouver | Reference | Reference |
| Toronto | 1.03 (0.70–1.53) | 1.42 (0.81–2.52) |
| Montréal | 1.49 (1.07–2.08) | 1.07 (0.62–1.86) |
| Year | ||
| 2019 | Reference | Reference |
| 2018 | 1.37 (0.94 –2.00) | 1.96 (1.09–3.52) |
| 2017 | 2.26 (1.48–3.43) | 1.97 (1.01–3.87) |
Note: CI = confidence interval, OR = odds ratio, PrEP = pre-exposure prophylaxis.
All estimates are respondent-driven sampling (RDS)-adjusted.
Other variables that were explored included sexual orientation, ethnicity, other HIV prevention strategies (seropositioning, serosorting, PrEP, withdrawal), impact of PrEP use on sexual behaviour (“PrEP would allow me to have the sex I want,” “If a guy is using PrEP it makes using condoms during anal sex less important”), community receptivity of PrEP (“PrEP is well-perceived in the community,” “I am worried about being negatively judged for taking PrEP”), access to health care services (ease of accessing PrEP, “Clinics where I could get PrEP are too far away,” “Most doctors do not know enough about PrEP to be comfortable prescribing it”), implications of ongoing use of pre-exposure prophylaxis (“I would have difficulty taking PrEP medication every day”), HIV treatment optimism–skepticism scale,45 Collective Self-esteem Scale,46 Sexual Compulsivity Scale,47 sexual altruism scale48,49 and Condom Barriers Scale.50