Effects of migration status on HIV pre-exposure prophylaxis (PrEP) uptake among gay and bisexual men in Australia: Results from the PrEPARE Project 2023

Abstract

Introduction

Increasing HIV diagnoses rates among migrant gay and bisexual men (GBM) in Australia highlight the importance of accessing HIV prevention, especially among recently-arrived GBM. We compared GBM who were willing to use but not using pre-exposure prophylaxis (PrEP) with current PrEP users and assessed effects of migration status on PrEP uptake.

Material and Methods

A national, online cross-sectional survey of GBM was conducted in June–July 2023. Migration status was measured by region of birth and length of residency. Those willing to use but who had never used PrEP were compared with current users by logistic regression.

Results

Of 2,046 respondents, 1,907 (93.2%) were HIV-negative/untested with 947 (80.6%) currently using PrEP and 228 (19.4%) willing to use PrEP. Among PrEP users/willing participants (n=1,175), 28.3% were born overseas, including 4.1% who had recently arrived (lived in Australia <2 years). Compared to those who were willing but had never used PrEP, current PrEP users were older (aOR=1.03, 95%CI=1.02-1.05), more likely to be employed (aOR=1.83, 95%CI=1.04-3.20), know at least one PrEP user (aOR=2.05, 95%CI=1.26-3.34), have received an STI diagnosis in the last year (aOR=2.37, 95%CI=1.34-4.19), report >10 recent male sexual partners (aOR=11.28, 95%CI=4.24-29.96), and report condomless anal sex with casual partners in the past 6 months (aOR=4.47, 95%CI=2.83-7.08), and less likely to be recently-arrived GBM from non-high-income English-speaking countries (aOR=0.22, 95%CI=0.07-0.65),. Fewer recently-arrived GBM from non-high-income English-speaking countries used PrEP (50.0%) compared to Australian-born GBM (81.7%), GBM from high-income English-speaking countries (84.0%) and non-recently arrived GBM from other non-English-speaking countries (81.6%; X²(3, 1175)=30.27, p<.001). Most recent arrivals spoke a language other than English at home (90.4%) and had migrated alone (82.7%), primarily for education (59.6%).

Discussion

PrEP uptake was concentrated among more sexually active GBM and much less common among recently-arrived GBM. Free or low-cost access schemes, supported by translators, publicised through educational institutions and PrEP users’ social networks may help promote PrEP uptake among recently-arrived GBM.