Gearing up for PrEP in the Middle East and North Africa: An Initial Look at Willingness to Take PrEP among Young Men Who Have Sex with Men in Beirut, Lebanon

Abstract

The Middle East and North Africa (MENA) is one of only two global regions where rates of HIV are currently on the rise. In Lebanon, new HIV infections are increasing most rapidly among young men who have sex with men (YMSM). While, the majority of YMSM in Lebanon report having recently engaged in condomless anal intercourse, many report reluctance to seek HIV prevention services for fear of stigma and discrimination. Pre-exposure prophylaxis (PrEP) is an effective alternative HIV prevention strategy but there is a dearth of research looking at willingness to take PrEP among YMSM in MENA. This study is the first to delineate factors associated with willingness to take PrEP among a cohort of 218 YMSM recruited from Beirut, Lebanon. Over half (55.5%) reported willingness to take PrEP. At the bivariate level, knowledge of HIV risk, awareness of PrEP, being in a relationship, greater judgementalism about sex in communication with peers, greater number of types of gay-related discrimination experienced, sense of community among YMSM, having had recent condomless anal sex with positive or unknown status partner, and the use of substances just prior to or during sex were each associated with greater willingness to take PrEP. When entered into a linear regression analysis, use of substances just prior to or during sex and sense of community among YMSM remained significant predictors of PrEP willingness. Intervention efforts focused on increasing PrEP uptake among YMSM in MENA should consider the influence substance use and social factors on willingness to take PrEP.

Keywords:

• Beirut
• gay community
• HIV-prevention
• Lebanon
• peer communication
• PrEP
• substance use
• young men who have sex with men

Disclosure statement

No conflicts of interest exist for any of the study authors.

Ethical Approval

All study protocols and procedures involving human subjects were approved by the Institutional Review Board of the RAND Corporation and were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

We obtained informed consent from all participants included in this study.

Additional information

Funding

This study was funded by the US National Institute of Mental Health (Grant R01MH107272; PI: G. Wagner) with addition funding for Dr. Storholm provided by the US National Institute on Drug Abuse (grants R03DA043402 and R21DA044073; PI: E. Storholm)