Preplanned Studies: Analysis of Knowledge Level and Use of Antiretroviral Pre-Exposure and Post-Exposure Prophylaxis Among MSM — China, 2019–2022

Men who have sex with men (MSM) have a high HIV infection rate, with more than one-fifth of newly infected people having sex with men (1). The overall national prevalence of HIV among MSM during the period of 2001 to 2008 was estimated to be 5.7% (2). Prevention and control of HIV epidemics among MSM are challenging. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) can effectively prevent HIV infection among MSM, and have been promoted and implemented in many countries with guidelines developed by the World Health Organization (WHO) (3). To learn about the cognition and use of PrEP and PEP among MSM in China, we conducted cross-sectional surveys in 2019, 2021, and 2022, respectively.

This study revealed that knowledge and utilization of PrEP and PEP among MSM were relatively low. To reduce the risk of HIV infection among MSM, more publicity and education should be employed to increase awareness of PrEP and PEP and to promote their use.

This study was conducted by MSM community organizations in the survey areas from March to April 2019 in Beijing Municipality and Shenzhen and Kunming cities; January to March 2021 in Beijing Municipality and Shenzhen, Chengdu, Jinan, and Nanjing cities; and April to June 2022 in 22 cities and municipalities, including Tianjin, Chengdu, and Hangzhou. The cross-sectional studies of 3 years were approved by the Ethics Committee of the National Center for AIDS/STD and Prevention, China CDC. An anonymous WeChat-based questionnaire was distributed and accessed by respondents via a code scan. Each internet protocol (IP) address was only allowed for one enrollment. The local survey leader sent the questionnaire to eligible MSM as a seed, and then used an online snowballing method to invite them to answer the questionnaire and share it with their eligible peers.

The questionnaire included sociodemographic information, behavioral information, basic knowledge and use of PrEP and PEP for participants who met the inclusion criteria of being biological males aged 18 or older, having had sex with a male at least once in the past 12 months, and being HIV negative. Over the three-year period, 3,337, 5,313, and 15,758 MSM were enrolled, respectively.

Awareness of PrEP knowledge is defined as understanding the role of PrEP, the population for whom PrEP is intended, the methods of taking PrEP medications, and that PrEP does not replace condom use (4). Answering correctly the role and methods of taking PrEP, as well as the fact that PrEP does not replace condom use, is considered evidence of PrEP knowledge (5).

SAS (version 9.4, SAS Institute Inc., Cary, NC, USA) was used for statistical analysis. Spearman rank correlation was used to analyze the correlation between variables, with correlation coefficients (R) representing positive and negative correlations between variables. P-value of <0.05 (two-tailed) was considered statistically significant.

In this study, most of the participants were over 25 years old; this age group accounted for 73.6% (2,457/3,337), 78.5% (4,175/5,313), and 62.4% (9,835/15,758) of the total participants in 2019, 2021, and 2022, respectively. Most of the participants had college education or above, accounting for 73.1% (2,439/3,337), 69.2% (3,676/5,313), and 76.4% (12,036/15,758), respectively.

In the survey of the three years, the proportion of MSM who had sex in the past 6 months was higher than 60%, indicating that MSM had active sexual behaviors. More than 5% of MSM in the 3 years survey had HIV-positive sexual partners, and about 10% of MSM in the 3 years had concurrent sexual partners. On average, more than 25% of MSM used new drugs to increase sexual pleasure (Table 1). In general, MSM have a high risk of HIV infection, making them a key group in AIDS prevention and control. PrEP and PEP as new biotechnological means of AIDS prevention, have great significance in controlling the spread of AIDS in MSM.

The three-year survey found that the proportion of MSM who had heard of PrEP was high, all exceeding 70%. Over 60% of MSM had correct knowledge of the role of PrEP in preventing HIV, that PrEP is applicable to high-risk populations such as MSM, female sex workers (FSW), and intravenous drug users (IDU), and that condoms should be used simultaneously while taking PrEP.

The overall level of basic knowledge of PrEP among respondents was relatively low, with 10.2% (340/3,337), 17.8% (948/5,313), and 26.5% (4,179/15,758) in 3 years, respectively.

Results from the PrEP survey were similar to those of the three-year survey of MSM regarding knowledge of PEP. Over 70% of respondents correctly answered 3 questions related to PEP: its role in preventing HIV, its applicability to those who have engaged in high-risk sexual behaviors within 72 hours, and the need to use condoms while taking PEP. The overall level of knowledge of PEP was 35.7% (1,190/3,337), 34.0% (1,807/5,313), and 42.2% (6,657/15,758) in the three-year period, respectively.

In the 3 cross-sectional surveys, the proportion of MSM using PrEP was 6.0%, 14.4%, and 27.2%, respectively. The proportion of MSM using PEP was 11.2%, 14.4%, and 24.6%, respectively (Table 2).

According to the correlation analysis, there was a positive correlation between PrEP use and PrEP awareness, as well as between PEP use and PrEP knowledge awareness, and between PEP use and PrEP use (Table 3).