Background

In recent decades, several research studies have mentioned a potential mediating effect of health literacy (HL) on the relationship between social position and prevention behaviors. However, no studies have actually investigated this hypothesis on HIV prevention behaviors. The aim of this study is to investigate the mediator effect of HL on relationship between socioeconomic position (SEP) and preexposure prophylaxis (PrEP) uptake among men who have sex with men (MSM).

Method

This study is based on Rapport au sexe 2019 (ERAS 2019) survey. ERAS 2019 is an anonymous, self-administered online cross-sectional survey based in France on voluntary and specifically targeted to MSM. Education level and perceived financial situation were used as measures of SEP, while HL was assessed with the scale of HLQ “ability to actively engage with healthcare providers”. We performed mediation analysis with a model-based causal moderated mediation with mediation package in R software. Analysis were adjusted for age, place of residence, marital status and social support.

Results

Our study sample comprised 22,381 MSM including 17,554 HIV seronegative and 4,827 did not know their HIV status. The median [IQR] age was 30 [23-43] years. The majority of MSM had a level of education higher than the high school diploma (68.8%), had an adequate HL level (70.5%), and perceived their financial situation as comfortable (57.5%). PrEP uptake was very low (5.8%). PrEP users were more educated and perceived their financial situation as comfortable.

Mediation analyses showed that HL had weakly mediate the relationship between education level and PrEP uptake (proportion mediate average: 2%, 95%CI:   1%-5% p<0.001). However, the mediation effect of HL on the relationship between perceived financial situation and PrEP uptake was significant (proportion mediate average: 10%, 95%CI: 7%-16% p<0.001).

Conclusion

Patients' ability to engage with health care providers may offset the effect of poorer socioeconomic status on the uptake of PrEP as a prevention method. Raising awareness of PrEP among health professionals is a lever for reducing inequalities in access to this preventive measure. These results argue for the generalization of PrEP prescription by all health professionals, including general practitioners who are closer to the target population.