Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China

Abstract

ObjectivesThis study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated.Methods403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview.ResultsOnly 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP.ConclusionDifferent strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use.

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

“…The majority of our survey participants doubted PrEP and only a quarter (26%) selected that they would be willing to take PrEP despite the fact that it is one of the most promising modes of HIV prevention. Most studies in China have focused on rates of PrEP acceptance rather than actual uptake , and while reported levels of PrEP acceptance among Chinese MSM vary widely from 19.1% to 71.3% , uptake has been consistently reported as very low . Compared to younger MSM, our study identified those who were over 40 years old had higher rate of PrEP uptake.…”

Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year

“…Among GBMSM with experience of SDU in the past year who were not on PrEP, about 70% were willing to use daily PrEP in the next six months. The rate was higher than that of GBMSM in general in Hong Kong (27). Data on willingness to pay suggested that the current market rate for In addition, our study also showed that prevalence of SDU and chemsex among GBMSM in Hong Kong was lower than that of Western Europe, Australia, the United States and mainland China (5,6,(10)(11)(12)(13)(14).…”

“…or "definitely will". Such a definition has been commonly used in previous studies (27,60,61). For those with willingness to use PrEP, they were further asked about the maximum amount (in HK$) they were willing to pay per month for using daily PrEP.…”

“…In Hong Kong, due to the high cost of obtaining formal prescription in private clinics (US$1,000/month) and limited coverage of the PrEP demonstration project (70 participants), majority of local GBMSM PrEP users obtained the medication from overseas clinics or through online purchase (3). Previous studies showed that about half of Hong Kong GBMSM in general were willing to use free PrEP (3,27). GBMSM with experience of SDU might have higher interest to use PrEP.…”

“…In order to form such an intention, one would evaluate the pros and cons of the behavior (positive and negative attitudes), consider whether their significant others would support such behavior (perceived subjective norm), and appraise how much control one has over the behavior (perceived behavioral control). In recent published studies, the TPB has been successfully used to explain willingness to use PrEP among GBMSM in general (27), transgender women sex workers (36) and heterosexual population (37). Moreover, many published studies also used the TPB to explain sexual behaviors (38)(39)(40), and utilization of HIV testing (41) and antiretroviral therapy (42).…”