Knowledge Awareness Of Pre-exposure Prophylaxis And Motivation Model Of Willingness To Use Pre-exposure Prophylaxis Among MSM In Western China

Background：The situation of HIV/AIDS epidemic is serious. Anew safe, effective and feasible biomedical prophylaxis measure is urgentlyneeded. The HIV/AIDS pre-exposure prophylaxis (PrEP) is now the mostpromising biomedical prophylaxis for HIV. It has been initially provedthat it is safe and effective for the human being. Because of the big scale,multi sex partners and unprotected sexual behaviors, the MSM is the majorpopulation for new cases of HIV infection as well as the bridge populationfor HIV spreading, who directly impact the extent of HIV spreading inChina. Therefore, MSM will be an important latent population group forPrEP promotion. Knowing the knowledge awareness of PrEP andwillingness to use it among the MSM in China is significantly importantfor the implementation and promotion of PrEP strategy which will soon beproved by clinical trials.Objectives:（1）To know the knowledge awareness, using experience and wiliness to use it among the MSM in Western China in order to initiallyevaluate the feasibility of implementation and promotion of PrEP amongthe MSM in Western China.（2） To explore and analysis factors related to the wilinesssocio-demographically, health psychologically and ethologically in order toestablish the motivation model of willingness to use PrEP and to provideadvices for the establishing of the implementation and promotion strategyand for the correct and standard using of PrEP among MSM.Methods：（1）Literature and theoretic study: The literature study method wasused to know the international and domestic status on PrEP study,establish the study frame and complete the study design. The study on thecognitive theory in health psychology combined with the literature on PrEPwas studied to establish the motivation model of willingness to use PrEP.（2）Investigation methods: Four settings were chosen to do theinvestigation (Chongqing City, Nanchong in Sichuan, Nanning in Guangxiand Liuzhou in Guangxi). Participants were enrolled through thefollowing methods: snow-ball sampling, network enrolling and NGOs.Data were collected through both the method of quantitative questionnairesand in-depth interviews.（3）Data entering and analysis software: Data were entered into theepidata3.0. SAS9.1and smartPLS were used for quantitative data analysis. MAXqda2007were used to collect and analysis qualitativematerials.（4）Data analysis: Quantitative data were analyzed through statisticaldescription and inference. The motivation model was formulated on thebasis of the model of PLS equation of structure. Qualitative materialswere analyzed through both the generic analysis and scenario analysis.Conclusions:（1）The knowledge awareness on PrEP was relatively low amongMSM. It is needed for the MSM to fully know and exactly understand thePrEP for the PrEP implementation and promotion. The MSM of low-age,students and urban residents had relatively high knowledge awareness onPrEP. The newwork, MSM workshops, TV and friends were main waysfor MSM to get PrEP information. A few MSM have already started touse medicines to prevent HIV/AIDS. However, there is still no evidenceto show that there is someone who has exactly used PrEP.（2）Safety and effectiveness are the premise for MSM to accept PrEP.The MSM have relatively high command for the safety and effectiveness.If the two properties of PrEP were proved, the MSM would more willing touse it. There is initiative feasibility for the implementation and promotionof PrEP among MSM.（3）The MSM with low educational degree and low-middle incomewere more likely to use PrEP while students and officials in government/institutes/enterprises were less likely to use it. the higher theknowledge awareness on HIV/AIDS the stronger the willingness to usePrEP. The MSM who occasionally or never found sex partners on the net,ever had STD symptoms and went for free HIV/AIDS consultation weremore likely to use PrEP. Lowering the PrEP costs paid by buyers anddeveloping/selecting medicines with longer oral taking intermittent areprecipitating factors for PrEP taking. Most participants were likely tochoose capsule as the form of the medicine. Participants were mostwilling to get PrEP in CDC. The network, TV and MSM workshops werethe easiest and most expected ways to get PrEP information for the MSM.（4）The psychological factor is the inner and direct factor impactingthe willingness to use PrEP. The theoretical and empirical study show thatthe motivation model of willingness to use PrEP based on protectivemotivation theory can explain and predict the willingness from the aspectof psychological motivation, which is fit to the analysis of willingness touse PrEP. The threat perception, response efficacy and self-efficacypositively influence the willingness while response costs negativelyinfluences it.（5）The structural equation model can deal with the structuralrelationship between the measure of latent variables and latent variablesand deal with more than one dependent variables allowing measure error ofindependent variables, which has advantages in formula of motivation model of using PrEP. The results of least squares fitting and predictivetest are as the following: Q2>0, Blindfolding communality ofwillingness=0.667, Blindfolding redundancy=0.148. The model has certainpredictive function and relatively suitable for the formula of the motivationmodel of willingness to use PrEP.（6）Analysis on the relationship among the willingness relatedfactors, psychological motivation factors and the willingness: MSM withdifferent socio-demographical characteristics have different response costsfor PrEP, so there are differences among their willingness. Theknowledge awareness on HIV/AIDS mainly impacts on the threatperception in the psychological motivation factors and thus indirectlyimpacts on the willingness. The HIV/AIDS related behaviors andwillingness to use PrEP are reacted through their common reason variable(threat perception). The medicine factor and implementation model factorimpact the willingness through acting on the three coping appraisalvariables in psychological motivation factors. Therefore, interventionscould be carried out on the other relevant factors of willingness, such asknowledge awareness, medicine factors, implementation model et al, tolower the response costs and strengthen the response efficacy andself-efficacy and thus promote the using of PrEP among MSM.Meanwhile, during the promotion process of PrEP, consultation andpsychological could be used to directly impact the psychological motivation factors and thus promote the using and continuity of PrEP.Suggestions and assumptions:（1）The promotion model of “government leading, CDC managing,hospitals joining, volunteers organizing and coordinating, cost sharing” issuggested.（2）Various publicizing ways, such as the network, media, MSMNGOs and so on, should be used for exact and objective report of thePrEP trial and dissemination of PrEP relevant knowledge.（3）The health education on HIV/AIDS prevention should beenhanced, the publicizing of HIV/AIDS knowledge should be moreextensive and the epidemic of HIV/AIDS information should be moretransparent to reduce the discrimination of common people for HIVinfection and to guide common people to treat MSM and HIV infectedpeople more objectively.（4） Strong measures should be carried out to prevent thephenomenon of sexual behavior disinhibition.（5）The study on PrEP should be continued to optimize themedication scheme. During the implementation and promotion of PrEP, themonitoring and evaluating system of PrEP should be set up to furthermonitoring and evaluation of the efficiency of PrEP and further perfect theimplementation and promotion model of PrEP..