Acceptability Of HIV Post-exposure Prophylaxis Service And Its Related Factors Among Men Who Have Sex With Men

BackgroundAIDS is a serious infectious disease that could threaten human health.Men who have sex with men(MSM)are at high risk of getting HIV infection.In recent years,the homosexual transmission has been the second most common transmission route of AIDS,only after the heterosexual transmission.Among the newly discovered HIV/AIDS patients,the proportion of MSM has increased from 1.5%in 2006 to 23.6%in 2018.In 2017,the HIV infection rate among MSM in China was 7.75%.At present,the effectiveness of HIV interventions in China is limited,so new biomedical interventions are needed as supplements to curb the HIV epidemic among MSM.HIV non-occupational post-exposure prophylaxis(nPEP)refers to taking antiviral drugs to reduce the possibility of HIV infection after suspicious exposure to HIV through non-occupational routes.At present,the effectiveness of nPEP has been confirmed internationally,and many countries have published nPEP guidelines that are suitable for their situations.Although PEP has been carried out for many years in the occupational population in China,the intervention has not been widely carried out in non-occupational population.MSM are the key population of nPEP promotion,and it’s very important to understand their acceptability of nPEP before extensive promotion.In the meantime,it provides a scientific basis for further research and policy formulation related to nPEP.ObjectivesThe purpose of this study is to understand the awareness,willingness and related needs of nPEP among MSM in China,to explore associated factors affecting awareness and willingness of nPEP,and to provide a scientific basis for further research and policy development of nPEP.MethodsCross-sectional study was conducted in Shijiazhuang,Hebei Province and Xiamen,Fujian Province,and data were collected through the combination of qualitative and quantitative research.The qualitative study used in-depth interviews and focus group discussions to understand the behavioral information for MSM,the acceptability of nPEP and related needs,the status and difficulties of nPEP services.All focus group discussions and in-depth interviews were recorded and then transcribed verbatim.Data were coded using ATLAS.ti 5.0,analyzed and summarized using the thematic data analysis.In quantitative study,participants were recruited offline,using electronic questionnaires to complete the survey.Questionnaires were exported to form database using the electronic platform system,and invalid questionnaires were eliminated.Descriptive analyses were used to describe demographic information,behavioral information,specific questions of nPEP,etc.,and X2 test was used to evaluate the differences between the two regions.Using awareness and willingness of nPEP as dependent variables respectively and the demographic and behavior information as independent variables,the univariate Logistic regressions were conducted respectively.The variables with p-value<0.1 were entered into the multivariate Logistic regressions to calculate the OR value and the 95%confidence interval.P_value<0.05 was considered statistically significant.Results1.Qualitative studyA total of 21 MSMs were interviewed whose ages ranged 20 from 45 years old.Two focus group discussions were organized and a total of 11 medical workers participated.The study found that MSM people generally had casual sexual partners,and the frequency of condom use was not high.The main reasons for unwillingness to use condom were affecting sexual pleasure,having sex with the same person multiple times,and judging their health status according to their personal external conditions.The most common routes to know nPEP were the Internet and MSM community-based organizations.Most of the participants indicated the willingness to use the nPEP service,but mainly as an emergency remedy.The exposure risk,medicine and HIV stigma would affect the MSM’s willingness to use nPEP.At present,the implementation of nPEP includes:receiving the service at the hospital,prescribed prescriptions by doctor and getting the drug from the cooperative pharmacies,and referring to other hospitals.The price of medicine was between 3,000 and 4,000 yuan.The MSM generally believed that the nPEP services would not lead to an increase in r:isky behaviors.2.Quantitative study2.1 Demographic and behavioral characteristicsA total of 419 valid questionnaires were obtained in this study.The average age of participants was 28.04 years old.Among them,70.4%lived in the local area for more than 2 years,65.9%had a college degree or above,69.6%had a monthly income below 5,000 RMB,82.6%knew the basic knowledge of HIV,79.2%participated in HIV-related services.69.9%of participants have had anal sex in the past 6 months,34.2%of them had more than 2 sexual partners.73.4%of those who had anal sex with temporary partners can use condoms every time,but only 59.9%can use condoms every time with fixed sex partners.7.9%of all participants have used drugs,and only 37.2%of the participants tested HIV frequently.2.2 Awareness and willingness of nPEP and associated factors72.3%of participants had heard of nPEP,less than 70%of participants who had heard about nPEP correctly answered questions about duration,feasibility,and side effects.82.6%expressed the willingness to use nPEP，and 3.6%had used nPEP.In multivariate logistic regression analysis,living in the local area more than 2 years(AOR:2.976,95%CI:1.305-6.783),having a college degree or above(AOR:3.407,95%CI:1.575-7.368),sexual orientation was homosexuality(AOR:2.520?95%CI:1.146-5.541),participating HIV-related services(AOR:3.644?95%CI:1.189-11.165)were associated with higher awareness of nPEP,21-30 years old(AOR:2.285,95%CI:1.089-4.795)and 30 years old or older(AOR:3.106,95%CI:1.240-7.780),participating in HIV services(AOR:2.401,95%CI:1.126-5.120),using condom in the last sex(AOR:2.071,95%C/:1.043-4.520),having heard nPEP(AOR:2.870,95%CI:1.496-5.504)were associated with higher willingness to use nPEP.2.3 Needs for nPEP56.1%of participants indicated that the affordable price tor nPEP medicine was below 1,000 RMB.65.4%indicated that the favorite agency for nPEP services was CDC.63.4%indicated in MSM community-based organization,52.3%indicated in the hospital.As for the approaches to learn nPEP information in the future,71.6%hoped to learn it through the MSM organization,56.3%hoped to learn it on the Internet.2.4 Possible impact of nPEP for MSM high-risk behaviorsIf the nPEP was carried out among MSM,49.9%of participants thought that the frequency of condom use would not change for themselves,34.1%think others’condom use frequency may be declined.As for the number of sexual partners,66.8%think the number of sexual partners won;t change for themselves,54.2%think that the number of sexual partners of other MSM may be increased.Conclusion1.HIV knowledge and HIV-related behavior are separated among MSM.It has a good basis for nPEP to carry out among MSM because they had high awareness and willingness of nPEP services.It is recommended to accelerate the implementation of nPEP services in China.2.The associated factors affecting the awareness of nPEP are the time of living in the local area,education,sexual orientation and participation of HIV-related services.The associated factors affecting the willingness to use nPEP are the knowledge and participation of HIV-related service,awareness of HIV exposure risk,nPEP medicine and HIV stigma.It is recommended that the more nPEP information should be disseminated to people with lower age,lower education,higher mobility and lower participation in HIV-related service.3.Current nPEP service work procedure is not standardized in China,it is recommended to issue nPEP guideline as soon as possible to standardize the work process and set a reasonable price.Hospital can be the preferred institution for nPEP.The MSM organization can play an irreplaceable role in publicity,counseling,referrals,and facilitating follow-up.The Internet can play an important role in publicity work.4.While carrying out nPEP services,we should continue to strengthen behavioral education and interventions to reduce the number of new infections among MSM and control AIDS epidemic.