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Men who have sex with men in China are unsure about PrEP

Caitlin Mahon

21 February 2019

Gay men in China could benefit from more information around PrEP to increase uptake and curb new HIV infections in this group.

A chinese man standing in the street looking at his phone amidst a crowd
Photos are used for illustrative purposes. They do not imply health status or behaviour. Credit: iStock/xavierarnau

Just one-quarter (26%) of men who have sex with men (also known as MSM) surveyed in China said they would use pre-exposure prophylaxis (PrEP) should it become more accessible, with most (56.8%) participants doubting its efficacy as an HIV prevention method.

In this nationally representative survey of 4,581 men who have sex with men in China, it was also revealed that only 22.4% of participants had actually heard of PrEP before taking the survey. The authors note that there is an urgent need to develop targeted information and PrEP advertising campaigns for gay men in China, who represent a high-risk group for HIV.

National surveys in China have estimated HIV prevalence among Chinese men who have sex with men to be increasing rapidly, from 1.5% in 2005 to 8% in 2015. Other studies estimate even high HIV prevalence among urban gay men (9.9%), with some cities reporting prevalences as near 20%. Over a quarter of HIV diagnoses in China are among MSM, more than three times the rate of new diagnoses for MSM in other countries. PrEP has the potential to reverse this trend in China.

The men were recruited primarily through banner advertisements on “BLUED”, a popular gay dating app in China with over 27 million registered Chinese users. They were then linked to an internet-based survey of 30 questions that looked at their willingness to take PrEP and associated factors to their uptake preferences.

The respondents represented all of China’s 33 geographical areas, with those from Guangdong province, Shandong province and Beijing making up the largest shares. Most (65.2%) were young adults aged 18 to 25 and had high levels of education compared to the national population – with 68.6% having attended college.

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. They then compared the responses against demographic criteria and HIV risk behaviours.

Alarmingly, HIV risk-taking behaviour was common, with 43% of the men reporting unprotected anal intercourse. Of the participants who heard of PrEP, 26% indicated they would definitely take it, 49.6% said they would probably take it, while 24.4% said would not take PrEP.

Taking PrEP was associated with having heard of it before. Those with concerns around accessibility and cost were less likely to take PrEP. A lot of the men were concerned with PrEP-related side effects (69.9%), which was more common among younger gay men compared to older men in this cohort.

Unwillingness to take PrEP was associated with low perceived HIV risk, preference for condoms, and never having taken an HIV test.

Given the high response rate using this internet-based survey, the authors note that there is potential to also use these platforms as a means to provide information and education around PrEP – with a particular focus on boosting knowledge of PrEP effectiveness.

“Public health professionals should also try to address the medical mistrust that exists within this high‐risk population while promoting the use of the Internet as an accurate and confidential source of PrEP information.”

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