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

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Abstract

Introduction

HIV incidence among men who have sex with men ( MSM) is high in China. Pre‐exposure prophylaxis (Pr EP) 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 Pr EP and associated factors to their uptake preferences.

Methods

Between 19 January and 6 February, 2017, 4581 MSM aged over 15 years were recruited via a social networking app to take an online Pr EP 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 Pr EP, if they had concerns about Pr EP, and if they would be ready to uptake Pr EP should it be provided. When asked if participants were willing to take Pr EP, 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 Pr EP 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 Pr EP. When asked if they would uptake Pr EP, 26.0% said “definitely yes,” 49.6% were “probably yes,” and 24.4% said “no.” Pr EP adoption readiness was associated with having previously heard of Pr EP 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 Pr EP uptake willingness.

Conclusion

Young and well‐educated Chinese MSM reported a low willingness to uptake Pr EP despite being high‐risk for HIV. Effective education, especially through online mediums, will be critical to optimize this group's Pr EP uptake.

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Most cited references 36

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The increase in global HIV epidemics in MSM.

Chris Beyrer, Patrick H. Sullivan, Jorge Chamorro Sánchez … (2013)

Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Subepidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.

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High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.

Gaudensia Mutua, Frances Priddy, Eduard Sanders … (2013)

This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa, Kenya, who used oral pre-exposure prophylaxis (PrEP) for HIV prevention as part of a four-month trial of safety, acceptability and adherence. Fifty-one of 72 volunteers who took part in a randomized, placebo-controlled, blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessments after completing the trial. Analyses identified three themes: (i) acceptability of PrEP was high, i.e. side effects were experienced early in the study but diminished over time, however characteristics of pills could improve comfort and use; (ii) social impacts such as stigma, rumors, and relationship difficulties due to being perceived as HIV positive were prevalent; (iii) adherence was challenged by complexities of daily life, in particular post-coital dosing adherence suffered from alcohol use around time of sex, mobile populations, and transactional sex work. These themes resonated across dosing regimens and gender, and while most participants favored the intermittent dosing schedule, those in the intermittent group noted particular challenges in adhering to the post-coital dose. Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness.

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Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education.

Matthew Mimiaga, Patricia Case, Carey Johnson … (2009)

Preexposure prophylaxis (PrEP) could protect individuals engaging in repeated high-risk behaviors from HIV infection. Understanding the demographic and behavioral predictors of intent-to-use PrEP may prove useful to identify clinical trial participants. In 2007, 227 HIV-uninfected men who report having sex with men (MSM) recruited through modified respondent-driven sampling completed an interviewer-administered survey assessing prior PrEP use and awareness, future intent-to-use PrEP, demographics, sexual risk, psychosocial variables, and drug/alcohol use. Bivariate and multivariable logistic regression procedures examined predictors of intent-to-use PrEP. Mean age of participants was 41 (SD = 9.1); 54% were nonwhite. One participant reported prior off-label PrEP use (medication obtained from his HIV-infected brother). Nineteen percent had previously heard of PrEP, whereas 74% reported intent-to-use PrEP if available after being educated about its potential. In multivariable analysis controlling for age and race/ethnicity, significant predictors of intent-to-use PrEP included the following: less education [odds ratio (OR) = 7.7; P = 0.04], moderate income (OR = 13.0; P = 0.04), no perceived side effects from taking PrEP (OR = 3.5; P = 0.001), and not having to pay for PrEP (OR = 4.2; P = 0.05). Many New England MSM indicated an interest in using PrEP after learning about its potential, particularly if they could obtain PrEP at no expense and if PrEP had no side effects. Less educated MSM and those who knew less about PrEP and antiretroviral therapy before entering the study were more open to using antiretroviral therapy for prevention once they had received some information suggesting its potential value. Findings suggest that careful educational messages are necessary to ensure appropriate PrEP use if clinical trials reveal partial efficacy.

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Author and article information

Contributors

Fujie Zhang: treatment@chinaaids.cn

Journal

Journal ID (nlm-ta): J Int AIDS Soc

Journal ID (iso-abbrev): J Int AIDS Soc

Journal ID (doi): 10.1002/(ISSN)1758-2652

Journal ID (publisher-id): JIA2

Title: Journal of the International AIDS Society

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 1758-2652

Publication date (Electronic): 06 February 2019

Publication date Collection: February 2019

Volume: 22

Issue: 2 ( doiID: 10.1002/jia2.2019.22.issue-2 )

Electronic Location Identifier: e25242

Affiliations

[ ¹ ] Beijing Ditan Hospital Capital Medical University Beijing China

[ ² ] Clinical Center for HIV/AIDS Capital Medical University Beijing China

[ ³ ] Department of International Health SNHS Georgetown University Washington DC USA

[ ⁴ ] Blued Beijing China

[ ⁵ ] Department of Biology Georgetown University Washington DC USA

Author notes

[*] [* ] Corresponding author: Fujie Zhang, Beijing Ditan Hospital, Capital Medical University, Clinical Center for HIV/AIDS, Capital Medical University, No. 8 Jingshundong Street, Beijing, China. Tel: +86‐(10) 8432 2000. ( treatment@ 123456chinaaids.cn )

[†]

Joint first author with equal contribution.

Author information

Liming Wang https://orcid.org/0000-0002-8227-3656

Article

Publisher ID: JIA225242

DOI: 10.1002/jia2.25242

PMC ID: 6364490

PubMed ID: 30724470

SO-VID: bcd9bc43-1359-4133-afd4-325b63842177

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 23 July 2018

Date accepted : 16 January 2019

Page count

Figures: 0, Tables: 3, Pages: 9, Words: 8783

Funding

Funded by: Beijing Municipal Administration of Hospitals’ Youth Programme

Award ID: QML20171802

Funded by: Major Project of Beijing Municipal Science and Technology Committee

Award ID: D161100000416003

Custom metadata

source-schema-version-number 2.0

component-id jia225242

cover-date February 2019

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.5.8 mode:remove_FC converted:06.02.2019

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: prep uptake,prep knowledge,young chinese msm,hiv risk behaviours,hiv prevention

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: prep uptake, prep knowledge, young chinese msm, hiv risk behaviours, hiv prevention

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

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Most cited references 36

The increase in global HIV epidemics in MSM.

High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.

Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education.

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