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