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      Barriers to PrEP Uptake in Two Spirit, Gay, Bisexual, Trans and Queer Men, and Non-Binary People in Canada : An Analysis Considering Indigeneity, Ethnoracial and Gender-Diverse Identities within a Community-Based Health Survey

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            Abstract

            Background: Indigenous and ethnoracial minority Gay, Bisexual, Trans, Queer men, Two-Spirit, and non-binary (GBTQ2S+) people in Canada are often underrepresented in PrEP uptake within GBTQ2S+ population samples due to health and social inequities. We sought to determine barriers to PrEP use for sub-populations of HIV-negative GBT2Q based on ethnoracial identity and gender diversity.

            Method: Participants self-completed the national, online, anonymous, community-based Sex Now 2019 behavioural surveillance survey. Recruitment occurred via GBTQ2S+-oriented sex-seeking apps, websites, and social media from November 2019 to February 2020 (pre-COVID). Participants completed questions on demographics and PrEP-related barriers (e.g., low self-perceived HIV risk, cost, judgement from healthcare providers). Multivariable confounder bootstrapped (1000 iterations) logistic regression models assessed differences in various barriers to PrEP by ethnoracial identity, and stratified by cisgender/gender-diverse identity; possible confounders included age, income, and sexual orientation, if significantly correlated with the outcome. Beta coefficients (β) with 95% confidence intervals (CI) are presented.

            Results: Of 1137 HIV-negative Indigenous and ethnoracial minority GBTQ2S+ participants (85.5% cisgender men, 14.5% gender-diverse), 17.2% were Black/African/Caribbean, 29.2% were Indigenous, 20.0% were Latinx, 28.9% were East/Southeast Asian, and 21.9% were Arab/South Asian. Four ethnoracial differences in PrEP-related barriers were identified. First, low self-perceived HIV risk was less likely to be reported by Latinx (15.6% versus 23.2%, β=-0.75, CI [-1.41,-0.15]) and Arab/South Asian (17.8% versus 22.8%, β=-0.53, CI [-1.10,-0.056]) participants. Second, disliking taking pills was less likely to be reported by Arab/South Asian participants (8.7% versus 16.4%, β=-0.61, CI [-1.29,-0.11]). Third, cost as a barrier was less likely to be reported by Indigenous participants (19.9% versus 28.9%, β=-0.61, CI [-1.16,-0.11]). Fourth, judgement from healthcare providers was less likely reported by gender-diverse South Asian participants (8.0%, β=-1.54, CI [-22.33,-0.024]) versus all other gender-diverse participants (23.6%).

            Conclusion: Commonly reported PrEP barriers for Indigenous and ethnoracial minority GBTQ2S+ were self-perceived risk, cost, and judgement from healthcare providers. However, specific ethnoracial groups, intersecting with gender diversity, experienced these less. Although this data cannot encapsulate all PrEP barriers faced by these communities, it highlights the need for culturally-appropriate and gender-affirming health promotion strategies, new PrEP prevention efforts, and healthcare provider capacity-building to improve equitable PrEP implementation.

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            Author and article information

            Journal
            ScienceOpen Posters
            ScienceOpen
            5 September 2022
            Affiliations
            [1 ] School of Public Health and Social Policy, University of Victoria, Victoria, Canada
            [2 ] Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
            [3 ] Community-Based Research Centre, Vancouver, Canada
            [4 ] St. Michael’s Hospital, Toronto, Canada
            Author notes
            Author information
            https://orcid.org/0000-0002-7978-6514
            https://orcid.org/0000-0001-6545-1249
            https://orcid.org/0000-0002-3069-2875
            https://orcid.org/0000-0002-6336-8780
            Article
            10.14293/S2199-1006.1.SOR-.PP2KZVJ.v1
            3206dd40-87ad-4daf-8038-c90de4a330ad

            This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

            History
            : 5 September 2022

            The data that support the findings of this study are available from Nathan J. Lachowsky but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Nathan J. Lachowsky.
            Sexual medicine,Social & Behavioral Sciences,Public health
            gbMSM,Race and ethnicity,gender-diverse,Sexual and gender minorities,HIV/AIDS,Indigenous,PrEP,Prevention

            References

            1. Xi Min, Bullock Sandra, Mendelsohn Joshua B., Iveniuk James, Moravan Veronika, Burchell Ann N., Tan Darrell H. S., Daftary Amrita, Thompson Tamara, Lebouché Bertrand, Bisaillon Laura, Myers Ted, Calzavara Liviana. A national recruitment strategy for HIV-serodiscordant partners living in Canada for the Positive Plus One study: a mixed-methods study. BMC Public Health. Vol. 22(1)2022. Springer Science and Business Media LLC. [Cross Ref]

            2. Cespedes Michelle, Das Moupali, Hojilla J. Carlo, Blumenthal Jill, Mounzer Karam, Ramgopal Moti, Hodge Theo, Torres Thiago S., Peterson Charles, Shibase Senzokuhle, Elliott Ayana, Demidont A. C., Callaghan Larkin, Watson C. Chauncey, Carter Christoph, Kintu Alex, Baeten Jared M., Ogbuagu Onyema. Proactive strategies to optimize engagement of Black, Hispanic/Latinx, transgender, and nonbinary individuals in a trial of a novel agent for HIV pre-exposure prophylaxis (PrEP). PLOS ONE. Vol. 17(6)2022. Public Library of Science (PLoS). [Cross Ref]

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