title: Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention.
abstract: Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.
authors: The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA.
authors: George
authors: 0000-0003-2255-7582
authors: G
authors: Ayala
authors: The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA.
authors: Keletso
authors: K
authors: Makofane
authors: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA ; San Francisco Department of Public Health, San Francisco, CA, USA.
authors: Glenn-Milo
authors: GM
authors: Santos
authors: The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA.
authors: Jack
authors: J
authors: Beck
authors: Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
authors: Tri D
authors: TD
authors: Do
authors: The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA.
authors: Pato
authors: 0000-0001-6526-6860
authors: P
authors: Hebert
authors: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors: Patrick A
authors: PA
authors: Wilson
authors: The Global Forum on MSM & HIV (MSMGF), 436 14th Street, Suite 1500, Oakland, CA 94612, USA.
authors: Thomas
authors: T
authors: Pyun
authors: Urban Health Program, RTI International, San Francisco, CA, USA.
authors: Sonya
authors: S
authors: Arreola