Migration Status and HIV Pre-exposure Prophylaxis (PrEP) Uptake Among Gay and Bisexual Men and Non-binary People in Australia: Results of a National Cross-Sectional Survey

Increasing HIV prevention coverage among migrant gay and bisexual men (GBM) and non-binary people in Australia has become a priority, as recently arrived migrants are at higher risk of HIV acquisition than longer-term Australian residents. We compared GBM and non-binary participants who were willing to use but had never used pre-exposure prophylaxis (PrEP) before with current PrEP users, and explored how migration status was associated with PrEP uptake. A national, online cross-sectional survey of GBM and non-binary people was conducted in June–July 2023. Migration status was measured by region of birth and length of residency in Australia. Logistic regression was used to examine migration status, along with sociodemographic, behavioural, and health characteristics, as predictors of PrEP status. Of 2046 respondents, 1907 (93.2%) were HIV-negative/untested with 947 (80.6%) currently using PrEP and another 228 (19.4%) willing to use (but never having used) PrEP. Among PrEP users and willing participants (n = 1175), 28.3% were overseas-born including 4.1% who had recently arrived in Australia (< 2 years). Among recently-arrived willing non-PrEP-users, 87.5% were not covered by Medicare (Australia’s national health insurance scheme). Compared to current PrEP users, willing non-PrEP-users were younger, and more likely to be recently-arrived migrants, identify as bisexual/queer/other, and lived in regional and remote areas. They were also less likely to be in paid employment, know other PrEP users, or report recent STI diagnosis. Free or low-cost access schemes, supported by translators, publicised through educational institutions and relevant social networks may help promote PrEP uptake among recently-arrived GBM and non-binary people.