Barriers to PrEP Uptake in Two Spirit, Gay, Bisexual, Trans and Queer Men, and Non-Binary People in Canada
Bibliographic record
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".