Inequitable access to PrEP among gay, bisexual, and other men who have sex with men in Canada: A network analysis of social indicators

IF 3.6 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Barry D. Adam , Diego Monteza-Quiroz , Trevor A. Hart , Shayna Skakoon-Sparling , David M. Moore , Terri Zhang , Aki Gormezano , Daniel Grace
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引用次数: 0

Abstract

This paper examines demographic, structural, and syndemic variables to map facilitators and barriers to accessing pre-exposure prophylaxis (PrEP) among gay, bisexual, and other men who have sex with men (GBM) in the three largest cities in Canada, Vancouver, Toronto, and Montreal. Focusing on factors in the later stages of the PrEP cascade, this study first performed a logistic regression analysis and reports adjusted odds ratios, then entered statistically significant social indicators into a network analysis to profile the interrelated and sometimes mutually reinforcing social conditions that shape inequitable access to PrEP among Canadian GBM. Barriers to accessing a gay-friendly health care provider (HCP) and financial barriers remain primary nodes associated with inequitable PrEP access. These two nodes are, in turn, linked to other social indicators: experiencing stigma from an HCP, being less likely to be out to an HCP (most common among bisexual and queer men), and not being able to find an HCP accepting of their sexuality (most common among Indigenous, Black, and some other GBM of colour). The cost of PrEP was also a barrier, especially for less educated and un- or under-employed GBM, as well as newcomers to Canada, who more often lacked insurance for medications. These findings point toward the importance of having a primary HCP and finding an HCP who is culturally competent regarding the sexualities of gay and bisexual men, queer and trans people. These barriers may also explain other social inequities experienced by Black, Indigenous, and other GBM of colour, and by people who do not have health insurance that covers all or most of the cost of PrEP. This pattern of inequitable access to PrEP points toward the urgency of providing universal access without financial barriers (currently available in some Canadian provinces but not others) and supporting access points with a reputation for welcoming GBM in their full diversity.
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来源期刊
Ssm-Population Health
Ssm-Population Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
6.50
自引率
2.10%
发文量
298
审稿时长
101 days
期刊介绍: SSM - Population Health. The new online only, open access, peer reviewed journal in all areas relating Social Science research to population health. SSM - Population Health shares the same Editors-in Chief and general approach to manuscripts as its sister journal, Social Science & Medicine. The journal takes a broad approach to the field especially welcoming interdisciplinary papers from across the Social Sciences and allied areas. SSM - Population Health offers an alternative outlet for work which might not be considered, or is classed as ''out of scope'' elsewhere, and prioritizes fast peer review and publication to the benefit of authors and readers. The journal welcomes all types of paper from traditional primary research articles, replication studies, short communications, methodological studies, instrument validation, opinion pieces, literature reviews, etc. SSM - Population Health also offers the opportunity to publish special issues or sections to reflect current interest and research in topical or developing areas. The journal fully supports authors wanting to present their research in an innovative fashion though the use of multimedia formats.
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