Biopsychosocial Factors' Influence on PrEP-uptake Among Danish MSM

Pre-exposure prophylaxis (PrEP) is an antiretroviral treatment aimed at reducing the risk of acquiring HIV. PrEP is a particularly important preventative measure for men who have sex with men (MSM), as they account for 21% of new global HIV cases despite being a small percentage of the population. In Denmark, over 50% of the total HIV cases involve MSM, despite MSM only accounting for 5-10% of the total population. MSM face higher HIV transmission risks due to factors such as engaging in unprotected anal intercourse. In 2019, PrEP became available in Denmark, and by 2022 there were approximately 2000 users. Despite free access, PrEP uptake remains low, with a relatively small share of eligible MSM estimated to be using it. Research into barriers to PrEP willingness among MSM is needed to improve uptake. An online cross-sectional survey was conducted from April to May 2024 to investigate biopsychosocial factors that may influence PrEP uptake among Danish MSM. Participants (N = 210) were recruited via LGBT+-specific social media forums and Danish AIDS Foundation clinics. Logistic regression models were used to analyze the data. The analysis showcased that non-users of PrEP, compared to users of PrEP, had 2.02 (CI: 1.10-3.70) times greater odds of experiencing a high stigmatization in the healthcare system and 5.73 (CI: 2.80-11.69) times greater odds of having a high fear of side-effects of PrEP. Out of the 104 non-user participants 40% were eligible for receiving PrEP-treatment fulfilling the Danish treatment specific risk criteria. When investigating non-users' willingness to undergo PrEP-treatment, the results showed that non-users with a high fear of side effects had 2.00 (CI: 1.10-4.40) times greater odds of showing high PrEP willingness and non-users with a high self-assessed risk of HIV had 5.60 (CI: 2.00-15.40) times greater odds of having high PrEP willingness compared to non-users who assess themselves as at low risk. These results indicate that biopsychosocial factors such as fear of side effects, self-assessed risk of HIV, and stigmatization in the healthcare system may influence non-users' uptake and withholding their willingness to seek PrEP-treatment. Biopsychosocial factors such as fear of side effects, self-perceived HIV risk, and healthcare-related stigma influence PrEP uptake among non-users. Effective public health interventions targeting these barriers are needed to increase uptake.