Obstacles And Countermeasures Of HIV Drug Prevention Among Men Who Have Sex With Men

ObjectiveTo understand the needs,willingness and self-efficacy of utilizing HIV pre-exposure prophylaxis(PrEP)and post-exposure prophylaxis(PEP)among men who have sex with men(MSM)to determine the factors related to the use of PrEP/PEP,and to explore the countermeasures to promote MSM ustilizing PrEP/PEP servicesMethodsThis study was conducted in Hefei,Chengdu and Guangzhou during June to December 2018.We recruited participants through on-site recruitment by nongovernmental organization(NGO)working for MSM,MSM peer recommendation and online recruitment.The criteria for participants were:Chinese men over 18 years old,had unprotected anal sex with men in the past six months,have reported HIV negative or unknown infection status.HIV oral self-test for HIV preliminary screening after informed consent,and those with HIV negative results were included in this study.The participants obtained a coded electronic questionnaire by using mobile phone to scan the code,and then they completed the questionnaire independently and anonymously,The contents of the questionnaire mainly included demographic characteristics,sexual partners and sex behavior,HIV testing experience,the knowledge and previous using experience of PrEP/PEP,willingness and self-efficacy to use PrEP/PEP,the expected PrEP/PEP service and the potential impacts on their high-risk behavior if PrEP/PEP would be used among MSM in the future.Frequency,percentage and mean ± standard deviation(x±s)were used for general statistical description;univariate analyses were performed by χ2 test,t test,variance analysis and correlation analysis;non-conditioned logistic regression model and generalized linear mixed model were used to perform multivariate analyses.On the basis of the above,structural equation model was build to analyze the direct and indirect effectsResultsA total of 622 eligible MSM were included in this survey.The participants were between 18 and 62 years old,with an average age of 29.8±8.3 years;53.5%were bachelor’s degree and above;53.7%have local Hukou of surveyed city;82.2%were unmarried and 81.4%were gay or homosexual.Among participants,12.9%had been diagnosed with STDs;14.8%never been tested for HIV In the past six months,63.8%of participants had tested for HIV;73.0%and 46.5%of them had anal sex with male main partners and occasional or commercial partners without condom,respectively;8.7%had HIV-positive partners;94.5%had sought sexual partners by Internet,and 27.7%had ever used Rush.As assessed,67.2%and 51.9%of participants actually need PrEP and PEP respectively.Among participants,56.3%and 72.3%have heard of PrEP and PEP,4.3%and 8.0%have used it respectively;PrEP and PEP related knowledge scores were 5.12±2.50 and 4.77±2.41,with full marks of 20.3%and 10.6%,respectively The proportions of particrpants with low using willingness of PrEP and PEP were 35.4%and 32.8%,respectively.PrEP and PEP using self-efficacy were 12.7+3.9 and 12.7±5.0,21.2%and 35.7%of participants with full marks,respectivelyThe multivariate logistic regression analysis of PrEP using willingness showed that the low willingness of using PrEP among participants with local Hukou of surveyed city was 2.16 times(OR=2.155,95%CI=1.487～3.122)that of Hukou in other places;compared with the participants in Guangzhou,the likelihood of low willingness of using PrEP of particiants in Hefei and Chengdu would decrease(OR=0.261,95%CI=0.165～0.413 and OR=0.245,95%CI=0.158～0.381);no actual need for PrEP and never having used PrEP were both risk factors for low willingness of using PrEP(OR=1.466,95%CI=1.001～2.147;OR=7.167,95%CI=2.043～25.147);and having been tested for HIV in the past six months could increased the likelihood of the low willingness of using PrEP to 1.61 times that of the untested(OR=1.613,95%CI=1.091～2.386).The logistic regression analysis of PEP using willingness showed that the low willingness of using PEP among participants with local Hukou of surveyed city was 1.64 times(OR=1.635,95%CI=1.094～2.444)that of Hukou in other places;the low willingness of using PEP of particiants in Hefei and C hengdu were lower than that of in Guangzhou(OR=0.161,95%CI=0.095～0.272 and OR=0.205,95%Ci=0.128～0.327);never having heard PEP,never having used PEP and having been tested for HIV in the past six months were the risk factors for low willingness of using PEP(OR=1.883,95%CI=1.173～3.023;OR=5.116,95%CI=1.971～13.280 and OR=1.657,95%CI=1.081～2.540);while PEP knowledge and PEP using concerns were both protective factors,and for every 1 point increased of them,the possibility of low willingness of using PEP would decrease by 0.13 times(OR=0.870,95%CI=0.797～0.950)and 0.05 times(OR=0.948,95%CI=0.917～0.980)The analysis results of the generalized linear mixed model of PrEP using self-efficacy shows that:the PrEP knowledge and using concerns could improve PrEP using self-efficacy,and for each 1-point increased of them,PrEP using self-efficacy would increase 0.13-fold(OR=1.126,95%Ci=1.004～1.264)and 0.09 times(OR=1.090,95%CI=1.025～1.157).In addition,MSM self-discrimination indirectly affected PrEP using self-efficacy through PrEP use concerns with an effect coefficient of 0.035;PrEP knowledge and usage concerns were both having a direct effect on PrEP using self-efficacy,with effect coefficients of 0.08 and 0.13 respectively,The results of the generalized linear mixed model analysis of PrEP using self-efficacy showed that:the using self-efficacy of PEP among participants with non-local Hukou of the surveyed city increased by 1.33 times(OR=2.328,95%CI=1.182～4.589)than those who have local Hukou;having actual needs for PEP,having heard of PEP,having used PEP and not having been tested for HIV in the past 6 months could promote the PEP using self-efficacy,increased it by 2.51 times(OR=3.508,95%CI=1.759～6.994),1.34 times(OR=2.342,95%CI=1.047～5.233)and 4.92 times(OR=5.924,95%CI=1.768～19.846)and 1.25 times(OR=2.246,95%CI=1.102～4.577),respectively;in addition,for each 1-point increased of the PEP knowledge,PEP using self-efficacy would increase 1.42-fold(OR=2.423,95%CI=2.090～2.807)The main PrEP/PEP service information of participants expected to gain were efficacy of preventing HIV infection,side effects,costs and access ways,accounting for 79.7%,78.1%,74.3%and 68.0%,respectively.The expected access ways to get PrEP/PEP services were mainly CDC,NGOs working for MSM and the Internet,accounting for 75.6%,65.4%and 63.8%,respectively.ConclusionsThere was a great gap between high demand and low uptake of PrEP and PEP among MSM.Lack of knowledge related to PrEP and PEP,concerns about preventive effects,side effects and costs of PrEP/PEP,as well as lack of social support have prevented MSM from using PrEP/PEP.Therefore,countermeasures includes to strengthen needs of PrEP/PEP via information disseminating,to enhance acceptability through decreasing the cost of PrEP/PEP and to improve accessibility by delivering convenient PrEP/PEP services.