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PLoS One. 2019 Mar 29;14(3):e0213740. doi: 10.1371/journal.pone.0213740. eCollection 2019.

Barriers to HIV pre-exposure prophylaxis among African, Caribbean and Black men in Toronto, Canada.

Author information

University of Toronto, Department of Medicine, Toronto, Canada.
St. Michael's Hospital, Li Ka Shing Knowledge Institute, Center for Urban Health Solutions, Toronto, Canada.
University of Rochester School of Nursing, Rochester, NY, United States of America.
Women's Health in Women's Hands, Toronto, Canada.
Ontario HIV Treatment Network, Toronto, Canada.
Cincinnati Children's Hospital Medical Center, Department of Biostatistics and Epidemiology, Cincinnati, OH, United States of America.
Women's College Research Institute, Women's College Hospital, Toronto, Canada.
Chief Public Health Office, Charlottetown, Prince Edward Island, Canada.
University of Toronto, Departments of Medicine and Immunology, Toronto, Canada.



Single-tablet combination emtricitabine/tenofovir is highly effective as HIV pre-exposure prophylaxis (PrEP). Scale-up efforts have targeted men who have sex with men (MSM), but patterns of racial disparities in PrEP use have begun to emerge. African, Caribbean and Black (ACB) communities in Canada and USA are also disproportionately affected by HIV, and there is lack of guidance regarding PrEP implementation in this priority population.


ACB men from Toronto, Canada were recruited in community settings by peers. Participants completed a detailed socio-behavioural questionnaire. Biological samples were collected and tested for sexually transmitted infections. Willingness to accept PrEP was assessed in relation to actual and self-perceived risk of acquiring HIV, as well as demographic and behavioural variables.


424 ACB men were included in the analysis. ACB MSM were more likely to accept PrEP than ACB men only reporting sex with women (MSW; 50.0% vs. 23.6%). The most common reasons for PrEP non-acceptance were concerns regarding side-effects and low self-perceived risk. PrEP acceptance was lowest among younger men (12.5%) and those born in Canada (15.2%). Men with a high self-perceived HIV risk were more likely to accept PrEP (41.3% vs. 22.7% of men with a low self-perceived risk), but only 25.4% of men who were defined as being at high-risk, self-identified themselves as such.


Most ACB MSW were unlikely to accept PrEP, largely due to low self-perceived HIV risk, but PrEP acceptance among ACB MSM was similar to other contemporaneous Toronto MSM communities. PrEP acceptance was particularly low among younger ACB men and those born in Canada. Tailored strategies will be needed to effectively implement PrEP in Toronto ACB communities.

Conflict of interest statement

The authors have declared that no competing interests exist.

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