Uptake and gaps in HIV pre-exposure prophylaxis (PrEP) use among HIV-negative gay, bisexual, and other men who have sex with men (gbMSM) in Metro Vancouver, Canada before, during and following COVID-19

Antiretroviral medication taken prior to HIV exposure to prevent infection is known as pre-exposure prophylaxis, or PrEP. Men who have sex with men (MSM) are the most affected HIV risk-group in Canada. In randomized trials, PrEP has been shown to be about 90% effective in preventing HIV infection when taken regularly. In 2018, the BC Ministry of Health, through the BC Centre for Excellence (BC-CfE) in HIV/AIDS, began full public funding for PrEP for individuals at high risk of getting HIV. The initial uptake of PrEP through this program has been very high -- more than 5500 individuals have accessed PrEP through the program as of December 2019. Nearly all (99%) PrEP users through this program are male and most (70%) live in Greater Vancouver. However, the impact of PrEP on the HIV epidemic among MSM will depend on uptake by those most at-risk. Further, behavioural risk compensation (e.g., decreased condom use) may result in higher incidence of other sexually transmitted infections (STIs). The covid-19 pandemic has likely also affected MSM in terms of sexual behaviour and access to essential health services, including PrEP. This study aims to evaluate determinants and trends of initiation of PrEP among of HIV-negative MSM over a four-year period and to compare in incidence of new STIs, including syphilis, chlamydia, and gonorrhea, prior to and after starting PrEP, We also want to understand what are the common characteristics of factors of MSM who meet clinical eligibility criteria for PrEP but whom have never initiated its use. Lastly we wish to examine the impact of Covid-19 on sexual behaviour and PrEP use among MSM in BC. Through our study team's position within the BC-CfE and existing collaborations with government and community agencies, these results will directly influence provincial and national policies regarding PrEP access. Our results will inform health promotion and clinical interventions to support PrEP uptake and adherence among Canadian MSM.