HIV leadership programming attendance is associated with PrEP and PEP awareness among young, gay, bisexual, and other men who have sex with men in Vancouver, Canada

Closson et al. BMC Public Health (2019) 19:429 https://doi.org/10.1186/s12889-019-6744-y RESEARCH ARTICLE Open Access HIV leadership programming attendance is associated with PrEP and PEP awareness among young, gay, bisexual, and other men who have sex with men in Vancouver, Canada Kalysha Closson1,2, Sarah Chown3, Heather L. Armstrong1,4* , Lu Wang1, Nicanor Bacani1, Darren Ho5, Jody Jollimore5, Gbolahan Olarewaju1, David M. Moore1,4, Eric A. Roth6, Robert S. Hogg1,7 and Nathan J. Lachowsky1,8 Abstract Background: Young gay, bisexual, and other men who have sex with men (YGBM) may have reduced engagement and knowledge of HIV care and biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and Treatment as Prevention (TasP), compared with adult GBM. We sought to understand differences in HIV prevention awareness, health care access, and service utilization between youth (16–29 years) and adult (≥30 year) GBM, as well as factors associated with attendance in HIV leadership programming among YGBM living in the publicly funded PrEP setting of Vancouver, Canada. Methods: Sexually-active GBM were recruited using respondent-driven sampling (RDS) from February 2012 to February 2015. Participants completed an in-person computer-assisted self-interview every 6 months, up to February 2017, with questions on sociodemographic factors, awareness of biomedical HIV prevention strategies, and an HIV treatment optimism-skepticism scale. Participants were asked if they had ever attended either of two HIV-leadership programs designed for YGBM. Both programs involve multiple GBM-led education and social networking sessions operated by community-based organizations in Vancouver. Multivariable Glimmix confounder models assessed differences between youth and adult GBM. Among younger men, bivariate analyses examined factors associated with HIV-leadership program attendance. Results: Of 698 GBM who enrolled in the longitudinal study, 36.8% were less than 30 years old at the first study visit. After controlling for gender identification, sexual orientation, HIV status, and income in the past 6 months, younger GBM (n = 257/698) had lower awareness of biomedical HIV prevention strategies and less HIV treatment optimism compared with older GBM (n = 441/698). Among younger GBM who attended HIV-leadership programs (n = 50), greater awareness of biomedical HIV prevention strategies and higher HIV treatment optimism were reported, compared with non-attendees. (Continued on next page) * Correspondence: 1 British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada 4 Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Closson et al. BMC Public Health (2019) 19:429 Page 2 of 11 (Continued from previous page) Conclusion: Younger GBM, who are disproportionately affected by the HIV epidemic, are less aware of new prevention technologies than older GBM, but attending peer-based HIV-leadership programs ameliorates agedisparities in HIV-prevention knowledge and treatment optimism. Keywords: Gay, bisexual, and other men who have sex with men, Youth, Leadership, Health promotion Background Young adulthood is a life stage characterized by self and sexual exploration which can lead to higher incidence of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), higher substance use, and greater mental health concerns. Today, young gay, bisexual, and other men who have sex with men (YGBM) are initiating sexual activity in an era with increased access to HIV antiretroviral therapy used now for both treatment and prevention. However, YGBM continue to represent a key population in the global HIV epidemic [1]. In Canada, GBM represented 44.1% of all new infections in 2016, with over half of all new infections among those aged 15– 29 years old attributed to GBM [2]. Moreover, evidence suggests that HIV incidence may be increasing among younger generations of men [3]. Prior to relatively recent improvements in antiretroviralbased HIV prevention strategies, condom promotion and seroadaptive behavioral strategies were the main HIV prevention mechanisms promoted to and used by GBM [4]. These strategies continue to play a key part in comprehensive HIV prevention strategies, but new HIV transmissions persist [4, 5]. Prevention frameworks, including Coates’ 2008 highly active HIV prevention framework [6], acknowledge the need for multiple strategies including: 1) behavioral adaptations such as serosorting, seropositioning, and viral load sorting, 2) antiretroviral treatment for those living with HIV and campaigns like “undetectable equals untransmittable” (U=U) that highlight people with undetectable HIV viral loads cannot transmit the virus, 3) antiretroviral prevention interventions like pre-exposure prophylaxsis (PrEP) and post-exposure prophylaxsis (PEP), and 4) social justice and human rights, such as those that provide protection for all sexual orientations, gender identities, and gender expressions. Collectively, these strategies would reduce HIV transmission among GBM if the options are implemented equitably [1, 6, 7]. Unfortunately, important strides in prevention options are co-occurring against a background of persistent HIV stigma and homophobia [8–10]. Thus, despite increasing visibility of some gay men’s lives and greater awareness of the inequities experienced by GBM, frameworks for highly active HIV prevention are rarely adopted within health promotion initiatives. These realities have important implications for GBM in general, and particularly for younger GBM who are initiating their sexual lives in a climate of shifting societal norms and evolving HIV prevention technologies. In British Columbia, Canada PrEP is currently available at no cost to eligible individuals based on clinical guidelines, one criterion being a score of 10 or greater on the HIV incidence risk index for men who have sex with men (HIRI-MSM); PrEP eligibility favours younger men, as GBM aged between 18 and 28 years receive eight points on the HIRI-MSM tool just due to age [11]. Despite increased diversity in potential HIV prevention and treatment strategies, YGBM may not be r (...truncated)