Grant: Catalyst Grant: HIV/AIDS CBR Program - General Stream

Worldwide, gay, bisexual and other men who have sex with men (gbMSM) comprise a grossly disproportionate number of new HIV infections. This is true in Canada, where gbMSM have a 131-times higher risk of HIV than other men, and in emerging economies like China, where Shanghai faces an explosive new epidemic that is two-thirds gbMSM. PrEP (pre-exposure prophylaxis, the daily use of anti-HIV drugs by those at high risk) holds great promise for addressing this challenge, there has been little preparedness for its eventual rollout in Shanghai. While PrEP use is rising in Canada, ethnoracial minorities such as Chinese gbMSM are greatly underrepresented in existing clinical cohorts and research studies. More work is needed in both settings to understand the suitability, knowledge and acceptability of PrEP among gbMSM to guide both community-based education and advocacy efforts, as well as policy. We will conduct two parallel but distinct cross-sectional surveys to characterize community attitudes and readiness for PrEP among two cohorts of Chinese gbMSM, in Shanghai (n=400) and Toronto (n=100) respectively. We will quantify PrEP suitability, knowledge and acceptability within community-based samples in each city, assess community perspectives on barriers and facilitators of PrEP use in each context, and compare findings between the cities to identify culturally- and contextually-specific lessons learned. We will further compare the profile of participants reached through four different recruitment strategies, to inform plans for future work, and conduct stakeholder engagement to discuss implications and next steps. Our approach is informed by our prior work on advancing PrEP policy in Canada, including the identification of objective risk-based criteria for PrEP among gbMSM, and use of a hypothetical 'PrEP cascade' for assessing which gaps in preparing communities for PrEP require greatest attention.