JMIR Publications

ABSTRACT

Background:

Pre-exposure prophylaxis (PrEP) is currently one important tool for HIV prevention, especially in communities with higher risk of infection, notably men who have sex with men (MSM). To date PrEP has remained generally unavailable in many cities around the world. In the planning of strategies for PrEP targeting MSM, community assessment is crucial to understand members’ responses to the new intervention.

Objective:

Awareness and acceptance are two different but intricately linked contexts of PrEP. The aim of this paper was to identify determinants of awareness and acceptance of PrEP among MSM and to delineate their inter-relationships in Hong Kong where PrEP services have not been developed.

Methods:

An online questionnaire survey was administered in light of the popularity of the Internet as a platform for information and networking in the MSM community. Factors associated with PrEP acceptance and awareness were separately analysed and their predictors subsequently tested by multivariate logistic regression. Associations between acceptance and awareness of PrEP were examined by factor network analysis.

Results:

Between August and September 2016, results from a total of 453 HIV-negative MSM were analysed. Half (50%) of the respondents were aware of PrEP and 78% would consider using PrEP when it becomes available. Awareness of PrEP was associated with recent (P=.01) and on-going (P=.04) use of psychotropic drugs for sex (chem-sex). MSM who used online forums to seek sex partners had a lower awareness (P=.04) compared to those visiting physical venues for sex-networking. MSM who accepted PrEP were more likely users of Internet channels for sex networking (P=.049), especially location-based social network applications (P=.04). MSM accepting PrEP were more concerned about their partners’ HIV status (P=.002), history of sexually transmitted infections (P=.01), condom use (P=.02) and HIV testing behavior (P=.02). Multivariate logistic regressions revealed that PrEP awareness was related to one’s networking pattern whereas its acceptance was associated with inclination to self-protect from HIV. Factor network analysis highlighted the importance of chem-sex, which was linked by over half of the edges, while the rest were contributed by HIV testing behaviours.

Conclusions:

In Hong Kong the overall awareness of MSM towards PrEP was only moderate but their acceptance was higher. Targeting MSM with chem-sex behaviours through online platforms and parallel development of tailored HIV testing services are important when introducing PrEP in the community.