Willingness to Use Alternative HIV Prevention Methods among Internet-Using Men Who Have Sex with Men in Brazil: Implications for Pre-Exposure Prophylaxis and Home HIV Testing Öffentlichkeit

Abstract

Background: The HIV/AIDS epidemic in Brazil remains concentrated in populations with high vulnerability to infection, including men who have sex with men (MSM). This indicates an urgent need to develop alternative HIV prevention strategies. Pre-exposure prophylaxis (PrEP) and home HIV test kits are two promising approaches that can be utilized in an optimal comprehensive HIV prevention package targeted toward MSM.
Objective: The purpose of this study was to assess willingness to use PrEP and home HIV testing and their associated factors among MSM in Brazil, and to evaluate knowledge of and attitudes toward these alternative HIV prevention methods.
Methods: Data were collected through an online men's health survey conducted in April 2011 and targeted toward MSM in Brazil. The primary outcomes measured were likelihood of using PrEP and likelihood of using home HIV test kits. Logistic regression was used to model participant characteristics with each outcome in bivariate and multivariate analyses.
Results: Overall willingness to use PrEP and home HIV test kits among MSM was high: 67% were extremely or very likely to take PrEP, and 90% agreed that they would be likely to use home HIV tests. Only 22% had previously heard of PrEP. MSM who were aware of PrEP were more willing to use it compared with men who were unaware (OR = 1.7, 95% CI: 1.04-2.6), and these odds increased with age. Men who had anal sex recently also had increased odds of being willing to use PrEP (OR = 3.1, 95% CI: 1.1-8.3). The only significant predictor of probable home HIV test use was age (P = 0.04). MSM reported overall high willingness to use at-home testing under various hypothetical situations (P < 0.05).
Conclusions: MSM in Brazil are likely to use PrEP and home HIV testing as alternative methods of HIV prevention. Additional research is needed to determine the optimal components of a tailored HIV prevention package utilizing a combination of interventions for MSM and other high-risk populations.

Table of Contents

LIST OF TABLES .................................................................................................................. i

BACKGROUND .................................................................................................................... 1
PREP ................................................................................................................................... 3
HOME TESTING .................................................................................................................... 6
PUMA .................................................................................................................................. 7
OBJECTIVES ......................................................................................................................... 9

METHODS .......................................................................................................................... 10
DATA COLLECTION ............................................................................................................... 10
MEASURES .......................................................................................................................... 10
STATISTICAL ANALYSIS ........................................................................................................ 12

RESULTS ............................................................................................................................ 16
DEMOGRAPHICS, BEHAVIORAL CHARACTERISTICS,
AND ATTITUDES TOWARD PREP AND HOME TESTING ................................................................ 16
PREDICTORS OF LIKELIHOOD OF PREP USE ............................................................................. 17
PREDICTORS OF LIKELIHOOD OF HOME HIV TEST USE .............................................................. 19

DISCUSSION ...................................................................................................................... 21
PREP ................................................................................................................................... 21
HOME TESTING .................................................................................................................... 25
COMBINATION PREVENTION .................................................................................................. 29
LIMITATIONS ....................................................................................................................... 30
FUTURE DIRECTIONS ............................................................................................................ 32
CONCLUSION ....................................................................................................................... 34

REFERENCES ...................................................................................................................... 36

TABLES .............................................................................................................................. 41

APPENDICES ...................................................................................................................... 49
APPENDIX A: MEN'S HEALTH SURVEY ...................................................................................... 49
APPENDIX B: IRB APPROVAL .................................................................................................. 87

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General Health Sciences, Epidemiology
Stichwort	men who have sex with men HIV prevention PrEP MSM in Brazil HIV/AIDS in Brazil Internet-using MSM pre-exposure prophylaxis HIV/AIDS home HIV testing home HIV test kits
Committee Chair / Thesis Advisor	Sullivan, Patrick S, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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