Pre-exposure prophylaxis use, HIV knowledge, and internalized homonegativity among men who have sex with men in Brazil: A cross-sectional study

Background Pre-exposure prophylaxis (PrEP) use in Brazil remains low despite free national access. We explored associations of HIV knowledge and internalized homonegativity with PrEP use among PrEP-eligible men who have sex with men (MSM). Methods Brazilian Hornet users completed an online, cross-sectional survey in February-March 2020. We included cis-men >= 18 years old who reported recent sex with men and were PrEP-eligible per the following: condomless anal intercourse, partner(s) living with HIV, transactional sex, and/or sexually transmitted infection. Our outcome was current PrEP use, defined by the response, "I am currently taking PrEP." Key predictors included the HIV/AIDS Knowledge Assessment (HIV-KA) and Reactions to Homosexuality Scale (RHS); higher scores indicate greater knowledge and greater internalized homonegativity, respectively. Scales were standardized for analysis. Associations with current PrEP use were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Findings Among 2398 PrEP-eligible MSM, n = 370 (15 center dot 4%) reported current PrEP use. Increasing HIV-KA scores were associated with greater odds of PrEP use (aOR 1 center dot 70 [95%CI 1 cent 41-2 center dot 04], p < 0 center dot 001), and increasing RHS scores with lower odds of PrEP use (aOR 0 center dot 83 [95%CI 0 center dot 73-0 center dot 96], p = 0 center dot 010). PrEP use was lower among 18-24 versus 40+-years-old MSM (aOR 0 center dot 43 [95%CI 0 cent 27-0 center dot 69], p = 0 center dot 005), and in Black versus White/Asian respondents (aOR 0 center dot 51 [95%CI 0 center dot 31-0 center dot 85], p = 0 center dot 040). Interpretation Among PrEP-eligible Brazilian MSM, HIV knowledge was associated with increased PrEP use and internalized homonegativity with decreased use. Wider dissemination of HIV prevention knowledge and addressing stigma experienced by MSM could promote increased PrEP use. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)