Factors Associated with the Awareness of and Willingness to Use HIV Pre-exposure Prophylaxis Among Gay, Bisexual, and Other Men Who Have Sex with Men, Baltimore, MD, 2017-2019.

Pre-exposure prophylaxis (PrEP) is an effective tool in protecting persons from acquiring HIV infection through sex or injection drug use. However, awareness and willingness to use PrEP among Black gay, bisexual, and other men who have sex with men (BMSM) remain suboptimal compared to White MSM (WMSM) in the United States. Our aims were to (1) assess the factors associated with PrEP awareness and willingness to use PrEP among MSM and (2) compare the PrEP perceptions among BMSM versus non-Black MSM. Data were drawn from two cross-sectional behavioral surveys in Baltimore, MD: Behavioral Surveillance Research (BESURE) conducted in 2017, and Safe Spaces 4 Sexual Health (SS4SH), conducted in 2018 and 2019. Descriptive statistics were used to summarize the study population. We used Poisson regression models to identify variables associated with awareness of PrEP and willingness to use PrEP. PrEP perceptions were assessed via 13 items scored on a 5-point Likert scale. Finally, we conducted a post-hoc exploratory bivariate analysis of the relationship between PrEP perception and willingness to use PrEP, stratified by race/ethnicity. A total of 261 MSM participated in this study. Many of the participants were aware of PrEP (75.1%). Factors associated with greater PrEP awareness included having greater than a high school education (aRR 1.22, 95% CI 1.04, 1.43); and earning more than $25,000 annually (aRR 1.24, 95% CI 1.08, 1.42). Participants who had received money in exchange for sex one or more times were less likely to be aware of PrEP (aRR 0.59, 95% CI 0.36, 0.95). More than half of the participants were willing to use PrEP (55.3%). In bivariate and multivariable analyses, demographic or behavioral characteristics were not significantly associated with willingness to use PrEP. Higher agreement with the following statements was associated with lower willingness to use PrEP: "Having to take a pill every day is difficult" (RR 0.89, 95% CI 0.82-0.97) and, "I am concerned about the side effects of PrEP" (RR 0.89, 95% CI 0.82-0.96), and "PrEP is for people who have riskier sex lives than I do" (RR 0.86, 95% CI 0.78-0.95). Conversely, higher willingness to use PrEP was associated with comfortable having sex without a condom (RR 1.11, 95% CI 1.02-1.21), less anxious about sex (RR 1.12, 95% CI 1.02-1.24), and my friends think that I should take PrEP (RR 1.19, 95% CI 1.07-1.32). We found BMSM compared to non-Black MSM had higher mean scores related to taking a daily pill (p = 0.041), concerns about side effects (p = 0.012), concerns about people thinking they had HIV (p = 0.001), concerns about the financial costs of PrEP (p = 0.038) and caution when dealing with healthcare organizations/medical mistrust (p = 0.019). Perceptions with a statistically significant lower score among BMSM versus non-Black MSM included statements such as, comfortable having sex without a condom (p = 0.003) and less anxious about sex (p < 0.001). We conclude HIV prevention strategies, programs, and interventions should be cognizant of PrEP perceptions that facilitate or hinder PrEP uptake in Baltimore City, MD.

King H ，Thornton N ，Evans KN ，Tadfor Y ，German D ，Flynn C ，Jennings J ，Fields EL ... -  《-》

Awareness, willingness, and uptake of pre-exposure prophylaxis (PrEP) among men who have sex with men in Ghana.

HIV prevalence among men who have sex with men (MSM) in Ghana is 18.1% as compared to 1.6% in the general population. Pre-exposure Prophylaxis (PrEP) is recommended by the World Health Organization (WHO) for people who are HIV-negative and at high risk of acquiring HIV. Since PrEP introduction in Ghana in 2020, little is known nationally about the level of awareness, uptake, and willingness to take PrEP among MSM. This study aims to generate estimates on PrEP awareness, uptake and willingness to use among MSM in Ghana. We conducted a bio-behavioral survey among MSM aged 18 years and above in all the 10 traditional regions in Ghana from August 2022 to July 2023 using respondent-driven sampling (RDS). RDS-Analyst was used to compute weights based on the participants' network. Data analysis was restricted to MSM who were HIV-negative and sexually active to estimate the prevalence of awareness, willingness, and uptake of PrEP. A multivariable logistic regression model was used to assess the factors influencing these outcomes. Out of the 3,420 total MSM surveyed, 2,627 were HIV negative and were included in the analysis, Out of which 44.5% (95% CI: 42.0-47.0) were aware of PrEP, 90.4% (95% CI: 88.0-92.3) were willing to take PrEP and 17.8% (95% CI: 16.0 - 19.8) had ever taken PrEP. In the regression analyses, PrEP awareness was 5-fold higher among those who completed tertiary education (aOR: 5.56, 95% CI: 2.87-10.78, p < 0.001) and 4-fold among those who interacted with peer educators (aOR: 3.78, 95% CI: 2.52-5.67, p < 0.001). In terms of uptake, the odds were almost 9 times among those who had experienced forced sex (aOR: 8.88, 95% CI: 1.42-55.47, p = 0.02). MSM aged 25-34 were less willing to take PrEP (aOR:0.21, 95% CI 0.07-0.65, p = 0.006) and PrEP use was also less likely among those who consumed high alcohol (aOR:0.42, 95% CI 0.19-0.92, p = 0.03) and never tested for HIV (aOR: 0.44, 95% CI" 0.25-0.88, p = 0.017). In Ghana, awareness and willingness to take PrEP to prevent HIV is high, but uptake is low. These results highlight the need for interventions to improve the overall uptake of PrEP among MSM in Ghana, especially among those aged 25-34, high alcohol consumers and those who have never screened for HV. Effective implementation of these findings into the national policies can enhance access and encourage PrEP use, ultimately reducing HIV incidence in Ghana among MSM.

Apreku A ，Guure C ，Dery S ，Yakubu A ，Abu-Ba'are GR ，Addo SA ，Torpey K ... -  《-》

[Awareness, willingness, and status of using HIV pre-exposure prophylaxis among men who have sex with men in Shaanxi Province].

Li X ，Zhao YB ，Ren Q ，Jia H ，Chen T ，Wu Q ，Chang WH ... -  《-》

Preferences for Starting Daily, On-Demand, and Long-Acting Injectable HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in the United States (2021-2022): Nationwide Online Cross-Sectional Study.

Long-acting (LA) injectable preexposure prophylaxis (PrEP) and on-demand PrEP may improve overall PrEP uptake among men who have sex with men (MSM), but little is understood about the PrEP option preferences of MSM in practical scenarios where they may choose between various PrEP options. This study aims to examine the preferences for starting various PrEP options among a US nationwide online convenience sample of MSM from September 2021 to February 2022. Participants reporting no prior HIV diagnosis were provided brief descriptions of each PrEP option and were asked, "If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?" Those who said "yes" to multiple options were asked to rank them in order of preference. MSM currently taking daily oral (DO) PrEP were asked whether they would switch to on-demand or LA PrEP options. Log binomial models were created to examine the association between willingness to start or switch to on-demand and LA PrEP with various sociodemographic and behavioral factors. In the analytic sample (N=7760), among the participants who did not use any PrEP in the past 12 months (n=5108, 66%), 54% (n=2445) reported willingness to start at least 1 PrEP option and 41% (n=1845) of participants showed interest in starting multiple PrEP options. Overall, the highest willingness was reported for on-demand PrEP (n=2235, 44%), followed by DO PrEP (n=2174, 43%) and LA PrEP (n=1482, 29%). LA PrEP was ranked first among those interested in multiple options. Characteristics associated with ranking LA PrEP as a first option to start PrEP versus DO or on-demand PrEP were region of residence (residing in the West vs Northeast), report of sexually transmitted infection diagnosis in the past year, report of illicit drug use other than marijuana in the past year, and prior awareness of LA PrEP. Among current DO PrEP users (n=2379, 31%), 58% (n=1386) were willing to switch to on-demand or LA PrEP, and LA PrEP was ranked first among participants who were open to switching to both options. Willingness to switch to LA PrEP was higher among those who used illicit drugs other than marijuana in the past year, who heard of LA PrEP prior to the survey, and those who took 15 or less doses of oral PrEP in the last 30 days. LA PrEP was the highest-ranked option among most MSM who were willing to try multiple options or switch from DO PrEP. These findings highlight that LA PrEP might fill coverage gaps among MSM who use illicit drugs, have had a recent sexually transmitted infection diagnosis, and have less than optimal DO PrEP adherence.

Islek D ，Sanchez T ，Glick JL ，Jones J ，Rawlings K ，Sarkar S ，Sullivan PS ，Vannappagari V ... -  《JMIR Public Health and Surveillance》

PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey.

Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP. The PrEP APPEAL survey was a cross-sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self-identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness. Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower-middle-income countries (45.1%). The median age was 30 (25-36) years old. For the PrEP use cascade, 82.2% (n = 11,427/13,899) of participants were aware of PrEP, 35.0% (n = 4000/11,427) had used it before and 70.1% (n = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (n = 4068/7427) PrEP-naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (n = 2996/4068) of them expressed willingness to use PrEP and 83.0% (n = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system-level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual-level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness. While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale-up efforts. Future PrEP programmes should address system-level barriers to support PrEP uptake.

Wirawan GBS ，Schimdt HM ，Chan C ，Fraser D ，Ong JJ ，Cassell M ，Zhang L ，Tieosapjaroen W ，Phanuphak N ，Tang W ，Suwandi N ，Green KA ，Dobbins T ，Bavinton BR ... -  《-》