PrEP uptake preferences among men who have sex with men in China: results from a National Internet Survey

Abstract

Introduction HIV incidence among men who have sex with men (MSM) is high in China. Pre‐exposure prophylaxis (PrEP) is a promising mean to prevent HIV transmission but it is not widely available in China. We conducted a large Internet‐based online survey to assess the willingness of Chinese MSM to take PrEP and associated factors to their uptake preferences.MethodsBetween 19 January and 6 February, 2017, 4581 MSM aged over 15 years were recruited via a social networking app to take an online PrEP survey. HIV status at the time of the survey being conducted was not one of recruitment criteria. Participants were asked if they had heard of PrEP, if they had concerns about PrEP, and if they would be ready to uptake PrEP should it be provided. When asked if participants were willing to take PrEP, they were asked to select from the following responses: “definitely not,” “probably not,” “not sure,” “probably yes,” and “definitely yes.” In the final analysis, we grouped these five‐level Likert scale responses into three‐level responses as “definitely yes,” “probably yes,” and “no (definitely not/probably not/not sure).” Descriptive analysis and multinomial logistic regressions were conducted to assess the associations of PrEP adoption readiness and uptake concerns with HIV risk behaviours and demographic characteristics.Results MSM from 33 geographical regions of China participated in the survey. The majority were younger than 25 (65.2%) and had attended college (68.6%). HIV prevalence was high (6.8%) and 43.3% reported a history of unprotected anal sex. Only 22.4% of participants had heard of PrEP. When asked if they would uptake PrEP, 26.0% said “definitely yes,” 49.6% were “probably yes,” and 24.4% said “no.” PrEP adoption readiness was associated with having previously heard of PrEP and expressing concerns about accessibility and cost. Worries about side effects, low perceived HIV risk, preference for condoms, and never having received HIV testing were negatively associated with PrEP uptake willingness.ConclusionYoung and well‐educated Chinese MSM reported a low willingness to uptake PrEP despite being high‐risk for HIV. Effective education, especially through online mediums, will be critical to optimize this group's PrEP uptake.

Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China

“…Along with these PrEP promotion programs, awareness of PrEP (11-58% [5,[8][9][10][11][12]) and willingness to PrEP uptake (64-92%) [13,14] have increasing among MSM globally. The 2017 Chinese National Internet Survey among 4581 MSM showed that 22.4% of them had heard of PrEP and the majority (76%) would like to try PrEP [12].…”

“…Along with these PrEP promotion programs, awareness of PrEP (11-58% [5,[8][9][10][11][12]) and willingness to PrEP uptake (64-92%) [13,14] have increasing among MSM globally. The 2017 Chinese National Internet Survey among 4581 MSM showed that 22.4% of them had heard of PrEP and the majority (76%) would like to try PrEP [12]. In a recent study about half (46%) of 708 Chinese MSM were considered eligible for PrEP based on objective criteria (e.g., in a non-monogamous relationship, had condomless anal sex with a casual male partner in the past 3 months) [15], and 42% of 323 Chinese MSM selfperceived as appropriate PrEP candidates [16].…”

“…In a recent study about half (46%) of 708 Chinese MSM were considered eligible for PrEP based on objective criteria (e.g., in a non-monogamous relationship, had condomless anal sex with a casual male partner in the past 3 months) [15], and 42% of 323 Chinese MSM selfperceived as appropriate PrEP candidates [16]. Literature reported that facilitators of PrEP uptake included risky sexual behaviors, high self-perceived HIVrisk, and possessing a high level of HIV literacy [17,18], while barriers to PrEP uptake included worries about side effects, low positive expectations of its efficacy, and no experience of HIV testing [12].…”

Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese men who have sex with men

“…Meanwhile, previous studies have indicated that poor adherence to daily PrEP often leads to a dramatic compromising of its HIV prevention efficacy [10]. Furthermore, while some people with high risk behaviors in China have heard of PrEP, many may be uncertain about the efficacy of PrEP due to accessibility issues and insufficient knowledge, and thus do not intend to use it [11]. Individuals who engage in relatively high-risk behaviors are more likely to use PrEP [12].…”

Barriers and facilitators of Pre-exposure Prophylaxis (PrEP) intention among Chinese Men who have sex with men

“…However, while some people with high risk behaviors in China had heard of PrEP, many might not be certain about the efficacy of PrEP due to accessibility issues and insufficient knowledge, and thus do not intend to use it [8]. Both MSM and medical care workers are often concerned with the relationship between high risk sexual behaviors and PrEP use [9,10].…”