Generational Differences in Pre-Exposure Prophylaxis (PrEP) Intentions among Men Who Have Sex with Men: A National Study on Sexual Behaviors and Preventive Practices (Preprint)

Abstract

Background: In Brazil, Men Who Have Sex with Men (MSM) are disproportionately affected by the HIV epidemic, mirroring global trends. Despite advancements in HIV prevention, such as Pre-Exposure Prophylaxis (PrEP), uptake among different MSM age groups remains uneven, influenced by diverse sexual behaviors, risk perceptions, and social stigmas.

Objectives: To investigate factors associated with PrEP intentions among Brazilian MSM of different age groups.

Method: A cross-sectional electronic survey involving Brazilian MSM aged 18 years and above.

Results: PrEP intentions were expressed by over half of the participants, 55.1%. Regarding protective knowledge and PrEP intentions, among those under 25 years, frequent barebacking was associated with a 25.4 times higher prevalence of PrEP intentions. Conversely, having one or more casual sexual partners in the last 30 days was associated with a 22% lower frequency of PrEP intentions. The practice of chemsex was also associated with a lower prevalence of PrEP intentions. In the age group of 25-49 years, it was observed that the practice of double penetration was associated with a higher prevalence of PrEP intentions, as well as being a receptive or versatile partner. Still within this age range, the prevalence of PrEP intentions was over 10% among those who exhibited some unique characteristics, such as a previous diagnosis of syphilis and non-use of condoms due to the intensity of sex or when sexual partners are known. However, being single, the partner's PrEP use, and gouinage, as an HIV/AIDS prevention practice, were exclusively associated with lower prevalences of PrEP intentions. Regarding MSMs aged ≥50 years, a higher prevalence of PrEP intentions was associated with the practice of double penetration, as well as being a receptive or versatile partner. On the other hand, chemsex practice was associated with a lower prevalence of PrEP intentions. Group sex practice was independently associated with a lower prevalence of PrEP intentions exclusively among MSMs aged ≥50 years.

Conclusion: The study highlights significant generational differences in the factors influencing PrEP intentions among Brazilian MSM. It underscores the need for tailored HIV prevention strategies that consider the unique behaviors and perceptions of different age groups. By addressing these nuances, public health initiatives can better promote PrEP use, catering to the diverse needs of the MSM community and contributing effectively to the reduction of HIV infection rates.