Barriers to post exposure prophylaxis use among men who have sex with men in sub-Saharan Africa: An online cross-sectional survey

Background: Curbing new HIV infections among MSM in SSA remains problematic, due to cultural beliefs, norms that oppose same-sex acts, and criminalization of same-sex acts. No study focused on barriers to PEP use in SSA region has been conducted. Our study focused on identifying barriers to Post-Exposure Prophylaxis (PEP) use among MSM in sub-Saharan Africa (SSA). Methods: An online cross-sectional survey was sent out to members of 14 Lesbian, Gay, Transgender, Bisexual, Queer (LGBTQ) associations in SSA, to identify barriers to PEP utilization in MSM. A total of 297 MSM from 22 countries in SSA completed the survey between 8 January 2019 and 23 February 2019. Descriptive statistics were generated, chi-square and backward stepwise logistic regression analysis were performed to evaluate the association between the outcome "PEP use" and other variables. Results: Most of the MSM were aged 18 to 30, and the majority (220, 74.6%) described themselves as gay. Rwanda had the highest number of respondents (117, 39.7% of the total), followed by Nigeria, Ghana and South-Africa. The majority of respondents reported having heard about PEP (234, 80.7%), and the average PEP correct knowledge level was 59%. Five characteristics were associated with increased odds of using PEP: Age, having vocational education, having heard of PEP, knowledge of where to get PEP, and having been refused housing. Conclusion: There is a need for a collaborative effort between policy makers, key players in HIV prevention, and MSM associations in SSA to remove barriers to PEP uptake to promote optimal PEP utilization amongst MSM.