Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jul 28, 2025
Date Accepted: Dec 29, 2025
HIV Risk Profiles and PrEP/PEP Uptake among Men Who Have Sex with Men in Hangzhou, China: A Cross-sectional Latent Class Analysis
ABSTRACT
Background:
Men who have sex with men (MSM) continue to face disproportionate HIV burden globally and in China, despite the availability of effective biomedical prevention strategies such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). However, uptake of these interventions remains low and poorly aligned with individual risk levels.
Objective:
A deeper understanding of sexual behavioral factors and cognitive heterogeneity within MSM populations is critical for improving the uptake of PrEP and PEP.
Methods:
We conducted a population-based cross-sectional online survey among MSM in Hangzhou, China. Using latent class analysis (LCA), we identified typologies based on self-reported HIV-related risk behaviors and prevention knowledge. Multinomial logistic regression was used to examine sociodemographic predictors of class membership. Binary logistic regression models assessed associations between latent classes and recent PrEP/PEP uptake, adjusting for covariates.
Results:
Four latent subgroups were identified: low-risk and well-informed (37.3%), high-risk and well-informed (22.5%), moderate-risk and poorly-informed (25.4%), and high-risk and poorly-informed (14.8%). While PrEP and PEP use were highest among high-risk individuals, no significant difference in uptake was observed between well-informed and poorly-informed high-risk subgroups. The moderate-risk, poorly-informed group demonstrated the lowest PrEP (2.3%) and PEP (1.1%) use, despite reporting non-negligible behavioral risk. Membership in poorly-informed subgroups was significantly associated with lower education, lower income, rural people, and short-term residence.
Conclusions:
Our findings reveal substantial heterogeneity in HIV Risk Profiles and uptake of PrEP and PEP among MSM in China. Tailored, behaviorally informed interventions that address structural barriers and cognitive disparities are urgently needed. Differentiated HIV prevention frameworks—particularly for moderately at-risk yet underserved populations—may enhance the equity and effectiveness of PrEP/PEP strategies in China and comparable middle-income settings. Clinical Trial: Not applicable.
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