Barriers to post exposure prophylaxis use among men who have sex with men in sub-Saharan Africa: An online cross-sectional survey

Sandra Isano; Rex Wong; Jenae Logan; Soha El-Halabi; Ziad El-Khatib

doi:10.1016/j.pmedr.2020.101100

Barriers to post exposure prophylaxis use among men who have sex with men in sub-Saharan Africa: An online cross-sectional survey

Prev Med Rep. 2020 Apr 28:19:101100. doi: 10.1016/j.pmedr.2020.101100. eCollection 2020 Sep.

Authors

Sandra Isano¹, Rex Wong^{1

2}, Jenae Logan¹, Soha El-Halabi³, Ziad El-Khatib^{1

4}

Affiliations

¹ University of Global Health Equity (UGHE), Rwanda.
² Yale University, USA.
³ Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
⁴ World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada.

Abstract

Background: Curbing new HIV infections among MSM in SSA remains problematic, due to cultural beliefs, norms that oppose same-sex acts, and criminalization of same-sex acts. No study focused on barriers to PEP use in SSA region has been conducted. Our study focused on identifying barriers to Post-Exposure Prophylaxis (PEP) use among MSM in sub-Saharan Africa (SSA).

Methods: An online cross-sectional survey was sent out to members of 14 Lesbian, Gay, Transgender, Bisexual, Queer (LGBTQ) associations in SSA, to identify barriers to PEP utilization in MSM. A total of 207 MSM from 22 countries in SSA completed the survey between 8 January 2019 and 23 February 2019. Descriptive statistics were generated, chi-square and backward stepwise logistic regression analysis were performed to evaluate the association between the outcome "PEP use" and other variables.

Results: Most of the MSM were aged 18 to 30, and the majority (220, 74.6%) described themselves as gay. Rwanda had the highest number of respondents (117, 39.7% of the total), followed by Nigeria, Ghana and South-Africa.The majority of respondents reported having heard about PEP (234, 80.7%), and the average PEP correct knowledge level was 59%.Five characteristics were associated with increased odds of using PEP: Age, having vocational education, having heard of PEP, knowledge of where to get PEP, and having been refused housing.

Conclusion: There is a need for a collaborative effort between policy makers, key players in HIV prevention, and MSM associations in SSA to remove barriers to PEP uptake to promote optimal PEP utilization amongst MSM.

Keywords: HIV prevention; Key population; MSM; MSM, Men who have sex with men; PEP, Post-Exposure Prophylaxis; Post-exposure prophylaxis; SSA, Sub-Saharan Africa; Sub-Saharan Africa.