Pre-exposure Prophylaxis (PrEP) Awareness and Engagement Among MSM at High Risk of HIV Infection in China: A Multi-City Cross-Sectional Survey

Jun Du; Sainan Wang; Hongbo Zhang; Tao Liu; Shufang Sun; Cui Yang; Nickolas Zaller; Zhen Dai; Haipeng Zha; Yanqiu Zhao; Yue Zhao; Xuejiao Hu; Han Yan; Pan Gao; Jun Wang; Yehuan Sun; Zhihua Zhang; Operario Don

doi:10.1007/s10461-025-04633-x

Pre-exposure Prophylaxis (PrEP) Awareness and Engagement Among MSM at High Risk of HIV Infection in China: A Multi-City Cross-Sectional Survey

AIDS Behav. 2025 Jan 30. doi: 10.1007/s10461-025-04633-x. Online ahead of print.

Authors

Jun Du^#¹, Sainan Wang^#¹, Hongbo Zhang², Tao Liu³, Shufang Sun³, Cui Yang⁴, Nickolas Zaller⁵, Zhen Dai⁶, Haipeng Zha⁷, Yanqiu Zhao⁸, Yue Zhao⁸, Xuejiao Hu⁹, Han Yan⁹, Pan Gao¹⁰, Jun Wang², Yehuan Sun¹, Zhihua Zhang¹¹, Operario Don¹²

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China.
² Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.
³ School of Public Health, Brown University, Providence, USA.
⁴ School of Public Health, Rutgers University, Newark, USA.
⁵ Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock, USA.
⁶ Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan Province, China.
⁷ Chengdu Tongle Health Consulting Service Center, Chengdu, Sichuan Province, China.
⁸ Suzhou Center for Disease Control and Prevention, Suzhou, Jiangsu Province, China.
⁹ Wuhan Center for Disease Control and Prevention, Wuhan, Hubei Province, China.
¹⁰ Youth Public Health Service Center, Hefei, China.
¹¹ Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China. zhangzh@ahmu.edu.cn.
¹² Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE Atlanta GA, Atlanta, 30322, USA. don.operario@emory.edu.

^# Contributed equally.

PMID: 39883368
DOI: 10.1007/s10461-025-04633-x

Abstract

This study aimed to explore the awareness, willingness, and engagement with pre-exposure prophylaxis (PrEP) among high-risk Chinese men who have sex with men (MSM) and to investigate the factors influencing its use. A cross-sectional survey of 1800 HIV-negative MSM was conducted in Chengdu, Suzhou, and Wuhan between June 2022 and February 2023 through in-person and online recruitment methods. Univariate and multivariate logistic regression analyses were used to identify predictors of PrEP use. Bayesian network models were constructed using the bnlearn package in R 4.1.2, and inference was conducted using Netica software. Among the 1800 participants, 1467 had ever heard of PrEP, 696 were aware of its target population, and 195 had taken PrEP in the past 6 months. PrEP use was higher among individuals reporting multiple male sex partners, illicit substance use, alcohol use, HIV testing, PEP use, and sexual partners who had used PrEP. Conversely, having a female sexual partner was a barrier to PrEP use. Bayesian network modeling unveiled factors directly and indirectly impacting PrEP use. Variables like PrEP use of sexual partners, PEP use, alcohol use, HIV testing, and WeChat-based HIV knowledge platforms exhibited direct effects. Indirect effects included having a female sexual partner, number of male sexual partners, and illicit substance use. Despite high awareness, the usage of PrEP remains low among MSM. Encouraging social agencies to leverage social media platforms to provide comprehensive HIV care services, especially to meet the PrEP needs of MSM.

Keywords: HIV; High-risk; MSM; PrEP; Pre-exposure prophylaxis.

Grants and funding

R01MH123352/NH/NIH HHS/United States