Exploring drivers of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Malaysia

Abstract

Background Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy, particularly among men who have sex with men (MSM); however, PrEP uptake is below the threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia, where same-sex sexual behavior is illegal. Methods A sample of 355 participants completed an online survey between June and July 2020, recruited through geosocial networking apps for MSM and social networking websites (e.g. Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use within this population. Results The sample was predominantly Malay (53.5%), had monthly incomes greater than RM 3000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the adjusted multivariable logistic model, using drugs before or during sexual intercourse (“chemsex”) (AOR: 3.37; 95% CI: 1.44–7.89), being diagnosed with a sexually transmitted infection in the last 12 months (AOR: 2.08; 95% CI: 1.13–3.85), HIV testing in the previous 6 months (AOR: 3.23; 95% CI: 1.74–5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02–3.34) were associated with having taken PrEP in the past. Conclusions This study revealed that PrEP use among Malaysian MSM is relatively low, despite high awareness, and is associated with healthcare engagement and high-risk behaviors. These results highlight the need to tailor outreach activities for individuals at increased risk for HIV and those disengaged with the health system.

Clinic-Integrated Mobile Health Intervention (“JomPrEP” App) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and Multiphase Trial

“…Modeling studies for MSM suggest that pre-exposure prophylaxis (PrEP) is a highly effective strategy to avert new HIV infections [ 10 - 18 ]. PrEP uptake, however, is low among Malaysian MSM despite acknowledged high risk and strong interest in taking it [ 19 , 20 ]. Multilevel factors undermine the scale-up of HIV testing and subsequent linkage to PrEP services among Malaysian MSM.…”

Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta‐analysis

“…The 49 included studies [ 16 , 21 , 52 , 53 , 54 , 55 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 ] were published between 2009 and 2022 and recruited 46,157 MSM participants from 10 East and/or South Asian countries. Studies were conducted in China ( n = 20), Hong Kong ( n = 10), Thailand ( n = 6), Malaysia ( n = 4), multiple Asian countries ( n = 2), Cambodia ( n = 1), Indonesia ( n = 1), Japan ( n = 1), Taiwan ( n = 1), Singapore ( n = 1) and Vietnam ( n = 1).…”

“…The 49 included studies [16, 21, 52–55, 60–99] were published between 2009 and 2022 and recruited 46,157 MSM participants from 10 East and/or South Asian countries. Studies were conducted in China ( n = 20), Hong Kong ( n = 10), Thailand ( n = 6), Malaysia ( n = 4), multiple Asian countries ( n = 2), Cambodia ( n = 1), Indonesia ( n = 1), Japan ( n = 1), Taiwan ( n = 1), Singapore ( n = 1) and Vietnam ( n = 1).…”

Pre-exposure prophylaxis service among men who have sex with men in Malaysia: findings from a discrete choice experiment

“…As Malaysia emerges with a pilot PrEP program with only ~ 300 MSM on PrEP, the PrEP implementation gap is extraordinary to meet the needs of the estimated 220,000 MSM who can benefit from it. With high levels of stated interest in and awareness about PrEP 11 , government subsidy will only play one part of the role in optimal scale-up, especially in a country like Malaysia where there are extraordinary levels of stigma and frank discrimination toward MSM 12 as same-sex behavior is criminalized in secular and Shariah law 13 and reinforced in healthcare settings 14 . Innovations in addressing the complex interplay between individual and healthcare provider stigma, along with costs and other concerns related to PrEP, are crucial to understanding in order to develop PrEP delivery programs that are meaningful for MSM at risk for HIV.…”