Pre-exposure Prophylaxis (PrEP) Awareness and Engagement Among MSM at High Risk of HIV Infection in China: A Multi-City Cross-Sectional Survey

Overview

Journal AIDS Behav

Date 2025 Jan 30

PMID 39883368

Authors

Jun Du

Sainan Wang

Hongbo Zhang

Tao Liu

Shufang Sun

Cui Yang

Nickolas Zaller

Zhen Dai

Haipeng Zha

Yanqiu Zhao

Yue Zhao

Xuejiao Hu

Han Yan

Pan Gao

Jun Wang

Yehuan Sun

Zhihua Zhang

Operario Don

Affiliations

Soon will be listed here.

Abstract

This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.

References

Beyrer C, Baral S, Collins C, Richardson E, Sullivan P, Sanchez J . The global response to HIV in men who have sex with men. Lancet. 2016; 388(10040):198-206. DOI: 10.1016/S0140-6736(16)30781-4. View

He N . Research Progress in the Epidemiology of HIV/AIDS in China. China CDC Wkly. 2021; 3(48):1022-1030. PMC: 8633551. DOI: 10.46234/ccdcw2021.249. View

Guo Z, Feng A, Zhou Y, Gao Y, Sun Y, Chen Y . Geosocial networking mobile applications use and HIV and other sexually transmitted infections among men who have sex with men in Southern China: A cross-sectional study. Front Public Health. 2023; 11:1063993. PMC: 9944389. DOI: 10.3389/fpubh.2023.1063993. View

Yuan T, Fitzpatrick T, Ko N, Cai Y, Chen Y, Zhao J . Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data. Lancet Glob Health. 2019; 7(4):e436-e447. PMC: 7779827. DOI: 10.1016/S2214-109X(18)30567-9. View

Gao Y, Zhan Y, Sun Y, Zheng W, Zhang W, Fu L . Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men : A Randomized Controlled Trial. Ann Intern Med. 2024; 177(6):719-728. DOI: 10.7326/M23-3317. View

Chou R, Spencer H, Bougatsos C, Blazina I, Ahmed A, Selph S . Preexposure Prophylaxis for the Prevention of HIV: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023; 330(8):746-763. DOI: 10.1001/jama.2023.9865. View

Grant R, Lama J, Anderson P, McMahan V, Liu A, Vargas L . Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010; 363(27):2587-99. PMC: 3079639. DOI: 10.1056/NEJMoa1011205. View

Fu J, Dai Z, Wang H, Si M, Chen X, Wu Y . Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey. PLoS One. 2023; 18(10):e0293297. PMC: 10586652. DOI: 10.1371/journal.pone.0293297. View

Pan L, Xue H, Yu F, Shan D, Zhang D, Wang J . [Status and associated factors of pre-exposure prophylaxis use among men who have sex with men in 24 cities in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2023; 44(6):905-911. DOI: 10.3760/cma.j.cn112338-20220831-00749. View

10.

Han J, Bouey J, Wang L, Mi G, Chen Z, He Y . PrEP uptake preferences among men who have sex with men in China: results from a National Internet Survey. J Int AIDS Soc. 2019; 22(2):e25242. PMC: 6364490. DOI: 10.1002/jia2.25242. View

11.

Guo J, Kang W, Liu T, Xu J, Tang H, Lyu F . Analysis of Knowledge Level and Use of Antiretroviral Pre-Exposure and Post-Exposure Prophylaxis Among MSM - China, 2019-2022. China CDC Wkly. 2023; 5(13):292-296. PMC: 10150747. DOI: 10.46234/ccdcw2023.053. View

12.

Guo J, Zhang G, Qin Q, Chen H, Wang L, Lyu F . [Progress in research of knowledge, attitude and practice of pre-exposure prophylaxis in men who have sex with men and its influencing factors]. Zhonghua Liu Xing Bing Xue Za Zhi. 2022; 43(11):1854-1859. DOI: 10.3760/cma.j.cn112338-20220427-00351. View

13.

Sun Z, Gu Q, Dai Y, Zou H, Agins B, Chen Q . Increasing awareness of HIV pre-exposure prophylaxis (PrEP) and willingness to use HIV PrEP among men who have sex with men: a systematic review and meta-analysis of global data. J Int AIDS Soc. 2022; 25(3):e25883. PMC: 8901150. DOI: 10.1002/jia2.25883. View

14.

Huang Y, Tian R, Zhou Z, Xu J, Agins B, Zou H . HIV Pre-Exposure Prophylaxis Use on a Global Scale Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. AIDS Patient Care STDS. 2023; 37(4):159-191. DOI: 10.1089/apc.2022.0198. View

15.

Hillis A, Germain J, Hope V, McVeigh J, Van Hout M . Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming. AIDS Behav. 2020; 24(11):3056-3070. PMC: 7502438. DOI: 10.1007/s10461-020-02855-9. View

16.

Zhou Y, Chen Y, Lu J, Zhang Z, Sun Q, Liu X . Sustained high HIV incidence among men who have sex with men in Jiangsu province, China: based on the limiting-antigen avidity EIA method and six consecutive surveys, 2016-2021. Front Public Health. 2023; 11:1277570. PMC: 10694440. DOI: 10.3389/fpubh.2023.1277570. View

17.

Sun S, Yang C, Zaller N, Zhang Z, Zhang H, Operario D . PrEP Willingness and Adherence Self-Efficacy Among Men Who have Sex with Men with Recent Condomless Anal Sex in Urban China. AIDS Behav. 2021; 25(11):3482-3493. PMC: 8558112. DOI: 10.1007/s10461-021-03274-0. View

18.

Kyrimi E, McLachlan S, Dube K, Neves M, Fahmi A, Fenton N . A comprehensive scoping review of Bayesian networks in healthcare: Past, present and future. Artif Intell Med. 2021; 117:102108. DOI: 10.1016/j.artmed.2021.102108. View

19.

Wang L, Hong C, Chen L, John S, Simoni J, Wong F . Engagement Along the PrEP Care Continuum Among Men Who Have Sex with Men in China: A Systematic Review and Meta-analysis. AIDS Behav. 2024; 28(10):3270-3282. PMC: 11636660. DOI: 10.1007/s10461-024-04420-0. View

20.

Fuster-Parra P, Tauler P, Bennasar-Veny M, Ligeza A, Lopez-Gonzalez A, Aguilo A . Bayesian network modeling: A case study of an epidemiologic system analysis of cardiovascular risk. Comput Methods Programs Biomed. 2016; 126:128-42. DOI: 10.1016/j.cmpb.2015.12.010. View