Poor knowledge of HIV PrEP among MSM in Beijing, but high interest

Few gay and other men who have sex with men (MSM) in Beijing have heard of pre-exposure prophylaxis (PrEP), investigators report in PLoS One. Despite this, over two-thirds of men said that they would be willing to take or consider PrEP.

“To our knowledge this is the first study to assess awareness and acceptability of PrEP among MSM in China,” write the authors. “Awareness of PrEP was rather low…however, 68% reported that they were definitely or probably willing to accept PrEP if available.”

The study was carried out in 2009 and 2010 prior to release of results from the IPrEX study, an international trial which showed that pre-exposure prophylaxis with oral Truvada (tenofovir/FTC) reduced the risk of HIV infection in men who have sex with men.

PrEP is considered a promising area of HIV prevention, but the factors associated with willingness to accept PrEP, adherence and the treatment’s impact on sexual risk behaviour are poorly understood.

Most of the research evaluating PrEP acceptability has been conducted in the US and other western countries. There are an estimated 740,000 HIV-positive people in China and, in recent years, prevalence of the infection has increased substantially among gay and other MSM. PrEP could therefore provide a useful prevention intervention for this population.

Investigators from Beijing wanted to establish awareness and acceptability of PrEP among gay and other MSM in the Chinese capital.

They designed a study involving 152 men who were tested for HIV and syphilis in 2009 and 2010. All the men reported sexual activity with another man. An explanation of PrEP was read to the men and they were asked if they had ever heard of this prevention technology. Further details of the therapy – including the need for high levels of adherence and potential side-effects – were then read to the study participants, who were asked if they would be willing to accept the treatment.

The men had a mean age of 30 years. Most (85%) reported exclusively homosexual behaviour, the remaining 15% reporting sex with men and women.

A total of 17 individuals (11%) said they had already heard of PrEP.

Overall knowledge of HIV therapy was moderate. Only 69% of men had heard of antiretroviral treatment, and a third reported that they knew that the therapy could cause side-effects.

The men were asked about potential barriers to the use of PrEP.

Just under two-thirds of men (64%) said that they would be worried that they would be unable to work because of the side-effects of PrEP. A substantial proportion (45%) were also worried that PrEP would disrupt their sleep or diet. Some 44% said that they were worried that PrEP would not protect them from HIV and 22% were concerned about the possibility of resistance.

Stigma also appeared to be a barrier to the acceptance of PrEP. A fifth of men were worried that taking PrEP would mean that they would be regarded as “an AIDS patient”. Some men (15%) said they feared potential sexual partners would reject them if they were aware of their PrEP use.

Cost of therapy was also a potential barrier to use, with a quarter of men expressing concerns about the affordability of the treatment.

Analysis showed that inconsistent condom use in the previous six months and lower knowledge of the side-effects of antiretroviral drugs were significantly associated with an increased willingness to accept PrEP (both p < 0.001).

“PrEP should never be seen as the first line of defence against HIV,” write the authors. “Our results indicate that participants who do not insist on using condoms in homosexual behaviour showed higher willingness to accept PrEP. These results showed the competitive selection between PrEP and condom use that might occur.”

The authors therefore suggest that, should it become available, PrEP should be part of a comprehensive HIV prevention package. “Consistent condom use and PrEP…[and] other confirmed efficient strategies, should not be ignored when PrEP is introduced.”