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

Men who have sex with men (MSM) continue to bear a major burden of new HIV infections in Canada. Pre-exposure prophylaxis (PrEP) is a new approach to preventing HIV involving regular use of an HIV medication, that has been shown to reduce the risk of HIV among MSM in clinical trials. There are now urgent global calls for PrEP pilot or Demonstration projects that could further study how best to deliver PrEP in the real world. As front-line providers at community organizations and researchers serving Toronto MSM communities, our team has repeatedly received questions from clients about the possibility of making PrEP available in Toronto and the logistical challenges of doing so. We are therefore planning a PrEP Demonstration Project among MSM in Toronto, but have identified important design questions that need further input from potential PrEP users and the broader MSM community: Who is most appropriate/eligible for PrEP? How should messages about combining PrEP with condoms be communicated? Might PrEP become stigmatized, and what might be the consequences for a PrEP program? This catalyst grant will address these questions through four linked components. First, we will validate a new HIV risk assessment tool for assessing PrEP eligibility among MSM undergoing HIV tests at Hassle Free Clinic, to see if it is appropriate for use in our setting. Second, we will survey 400 of these men about their opinions of their own PrEP eligibility, PrEP messaging strategies, and PrEP stigma. Third, we will hold two sets of focus groups with potential MSM PrEP users and non-users to further explore opinions on PrEP messaging and stigma. Finally, we will hold a Community Forum to discuss our findings and their implications with the broader MSM community. A community advisory board will advise on the design and interpretation of each component. A key outcome of our project will be the development of a formal proposal for a PrEP Demonstration Project in Toronto MSM.