Racial disparities in HIV pre-exposure prophylaxis (PrEP) awareness and uptake among white, Black, and Indigenous men in Canada: Analysis of data from the I’m Ready national HIV self-testing study

Abstract

Objectives: Black and Indigenous men in Canada continue to experience significant and disproportionate burden of new HIV infection. The purpose of this study was to understand racial differences in PrEP awareness and use, and PrEP cascade among white, Black, and Indigenous men in Canada with the intention to provide evidence for immediate action in our publicly funded health care system. Methods: We performed a secondary analysis (n = 4294) of cross-sectional data from the I’m Ready national HIV self-testing research program launched in June 2021 and running through December 2023. Binary logistic regression was used to assess racial differences in PrEP awareness and uptake. A proposed PrEP cascade was developed using the data on awareness, uptake, and retention in PrEP care. Results: Black participants (OR = 0.34, CI 0.29, 0.39), who are gbMSM (OR = 0.27, CI 0.21, 0.35), aged 18–45 (OR = 0.35, CI 0.30, 0.40), living in urban (OR = 0.41, CI 0.33, 0.51) or rural areas (OR = 0.33, CI 0.26, 0.44), and who are PrEP-eligible (OR = 0.34, CI 0.28, 0.40), were less likely to be aware of PrEP than white participants. Indigenous participants (OR = 0.57, CI 0.44, 0.75), aged 18–45 (OR = 0.57, CI 0.43, 0.75), living in rural communities (OR = 0.15, CI 0.25, 0.57), and who are PrEP-eligible (OR = 0.62, CI 0.46, 0.83), were less likely to be aware of PrEP than white participants. For PrEP uptake, Black participants (OR = 0.61, CI 0.46, 0.82), aged 18–45 (OR = 0.59, CI 0.44, 0.80), living in rural communities (OR = 0.44, CI 0.23, 0.84), and PrEP-eligible (OR = 0.62, CI 0.46, 0.85), were less likely to be on PrEP than white participants. Also, Indigenous men living in urban areas were more likely to be on PrEP than white participants (OR = 1.65, CI 1.01, 2.69). Conclusion: Community-based and public health interventions are immediately needed to increase PrEP awareness, access, and uptake for Black and Indigenous communities in Canada.