Survey No. 1 Methodology & Demographics
The first, shorter survey was intended to collect high-level data concerning GBTQ men's experiences, knowledge, attitudes, and preferences as it related to PrEP access and coverage in Alberta. The survey was open for responses from June 9 to June 27, 2016. The survey was available for completion online only through Google Forms and was promoted via social media, primarily through Facebook and Twitter. A total of 372 on-target responses were received.
Most survey respondents (97%) identified as cisgender males and indicated having had sex solely with male partners in the preceding year (96%). Geographically, most respondents resided in Edmonton (81%), with some participation from Calgary (8%) and rural communities (4%). In terms of age, respondents were drawn from all age cohorts but skewed younger than middle-age, with 86% of respondents below the age of 40 and almost half (43%) between the ages of 20 and 29. Over half of participants were single (57%), while a significant proportion of respondents indicated being partnered in either a closed monogamous relationship (23%) or an open relationship (17%).
Findings & Analysis
Knowledge, eligibility and interest in PrEP is high, particularly after removing cost as a factor:
Respondents to the first survey were broadly aware of PrEP, with 85% reporting that they had heard of the medication. Based on criteria listed in draft Canadian PrEP/nPEP guidelines, recently released at the time of survey administration, 46% of respondents considered themselves eligible for PrEP.
(Note: These guidelines have since undergone some revisions, and have been finalized and published here).
Finally, if the cost of PrEP was completely covered without out-of-pocket payments, interest in obtaining a prescription was high. A total of 59% of participants stated they would want a prescription and an additional 30% would consider the option.
Respondents felt the government should pay for PrEP but many were willing to contribute a portion of the cost:
Those who indicated interest in obtaining PrEP were asked how much they would be willing to pay if PrEP was not completely covered. Approximately one quarter of respondents (24%) indicated they would not take PrEP if they had to pay any out-of-pocket costs. Another quarter (23.8%) indicated willingness to spend up to $100 per month out-of-pocket. Nearly half (47%) indicated willingness to pay $50 per month. Only 5% indicated willingness to pay $250 per month and only one respondent indicated being willing to spend more than $250 per month at $500.
Despite the willingness of about three quarters to pay some amount out-of-pocket for PrEP if necessary, more than half (53%) of all respondents indicated that the government should cover 100% of the cost of PrEP, with no out-of-pocket payments required of the individual. About 41% felt the government should only provide partial coverage, with the rest being paid either through private insurance or out-of-pocket. Only 1% of respondents felt it should be paid for 100% out of pocket.
Over four out of five respondents believe access to PrEP will improve GBTQ men’s health outcomes:
A total of 83% of respondents agreed that enhanced access to PrEP would improve health outcomes for gay, bisexual, trans, and queer men. Only 5% of respondents felt it would not improve the health of GBTQ men.
In being the first provincial survey aimed at exploring GBTQ men's experiences, attitudes, and preferences as it relates to PrEP access in Alberta, the data collected from a total of 372 on-target responses provides new and valuable insights. However, there are several limitations that must be recognized before making generalizations about the broader Alberta GBTQ male population:
Survey questions were general and only collected quantitative data. Respondents were not provided the opportunity to provide additional explanations or rationale behind their answers. The survey can answer questions like “how many?” but fails to provide information related to information like “why?”.
Given the study’s cross-sectional nature, the survey only provides a snapshot of the sample at one particular time; therefore caution should be used when attempting to use this data to make inferences about the sample’s current experiences, preferences, and attitudes as it relates to PrEP.
The sample was likely disproportionately cisgender, gay, young, urban, and white in comparison with the general Alberta GBTQ male population and therefore caution should be used when attempting to use this data to make broader inferences about the experiences, preferences, and attitudes of Alberta GBTQ men.
The survey was promoted via social media, primarily through Facaebook and Twitter, with a mix of organic peer-to-peer sharing and paid promotion through various Alberta LGBTQ social media pages. Although intentional efforts were made to share the survey widely, the sample is likely biased toward individuals who engage regularly with the specific social media platforms used to share the survey, those who are engaged with LGBTQ social media pages, and those who follow or are "friends" of social media accounts belonging to individuals who follow pages which employed paid/targeted “boosting” to promote the survey.
Survey respondents were able to participate in the survey voluntarily, leading to potential self-selection bias. Because of this, caution should be made before generalizing the results as there is a chance that the those who voluntarily chose to complete the sample might have a greater knowledge or interest in PrEP than the general Alberta GBTQ male population.