3.1 Sample current characteristics
MSM from thirty-four geographical regions of China participated in the survey, and total 1915 Chinese MSM enrolled in the final analysis. As shown in the Table 1, the majority were aged 21-30 years old (77.1%), with 17.0% aged twenty years or younger. Approximately one-in-five of participants lived in the central region of China and half of in Eastern China. And a total of 621 participants (32.4%) reported they were living alone. High levels of education and employment were evident among the sample, which more than three-quarters of participants (80.7%) had attended college and only 87 people (4.5%) were unemployed. A total of 1253 participants (65.4%) had annual income of less than $7,500. A small sample (8.3%) reported with over 6 male anal sex partners in the past 6 months and only (2.3%) reported having male sex partners with HIV positive. Additionally, almost a third of participants reported having condomless anal sex within the last six months.
Of the total 1915 participants, 512 (26.7%) had objective need to use PrEP; 1617 (84.4%) were willing to use PrEP; 106 (5.5%) participants reported that they could afford PREP and only 23 (1.2%) had actual uptake of PrEP for HIV prevention.
From Figure 1, we could notice that Area A represents those who are willing to use PrEP but do not have objective need, while Area B represents those who are willing to use PrEP and objectively need it. It is clear that most of the MSM population has a high willingness to use PREP, but may not actually be the top candidates for PREP promotion. It is also noteworthy that only 5.5% of the MSM in our study could afford PrEP, and even fewer actually used it. This suggests that there is a large gap between the demand for PrEP services and the actual use of PrEP among MSM.
3.2 Factors associated with current characteristics of PrEP multi-dimensionally among MSM in China
3.2.1 Influence factors associated with Objective need of PrEP for HIV prevention
Overall, 512 (26.7%) participants were investigated that they had objective need to use PrEP for HIV prevention. There were higher proportions of objective need to use PrEP among those who were aged range from 21 to 30 (82.6%), lived in eastern China (59.4%), had undergraduate education or above (78.1%), had an annual income of less than $7,500 (62.1%), had 0-5 male anal sex partners in the past 6 months (83.2%).
Univariate analysis indicated that significant variables associated with objective need to use PrEP included age, solitary, occupation. In multivariate logistic regression model, participants who were aged range from 21 to 30 (OR=1.47; CI:1.06-2.03), employees (OR=1.73;CI:1.37-2.19) were significantly more likely to need PrEP for HIV prevention, whereas those reporting living alone were significantly less likely to need PrEP (OR=0.67;CI:=0.54-0.85). (Table 2).
3.2.2 Influence factors associated with Willingness to use PrEP for HIV prevention
Not surprisingly, 1617 (84.4%) participants reported that they were willing to use PrEP for HIV prevention.
Univariate analysis indicated that significant variables included education, occupation, number of male anal sex partners in the past 6 months, HIRI-MSM risk score and condomless anal sex within the last six months. In multivariate analysis, those who had high school or above education were significantly more willing to use PrEP for HIV prevention, whereas those were unemployed were significantly less willing to use PrEP (OR=0.54; CI=0.32-0.93). (Table 3).
3.2.3 Influence factors associated with Affordability of PrEP for HIV prevention
Only 106 (5.5%) participants were investigated to indicate that they could afford PrEP for HIV prevention.
Univariate logistic regression model indicated that significant variables included age, annual income. In multivariate analysis, those who had annual income between 15000-30000$ (OR=2.22;CI:1.24-4.00) or over 45000$ (OR=4.56;CI:1.68-12.38) were significantly likely to afford PrEP, whereas those were aged range from 21-30 were significantly less possible to afford PrEP (OR=0.54;CI:0.33-0.89). (Table 4).
3.2.4 Influence factors associated with Uptake of PrEP for HIV prevention
Finally, only 23 (1.2%) participants reported that they had actual uptake of PrEP for HIV prevention in the past 6 months.
Univariate analysis indicated that significant variables included annual income, number of male anal sex partners in the past 6 months, HIRI-MSM risk score and condomless anal sex within the last six months. In multivariate analysis, those who had annual income between 30000-45000$ (OR=10.55;CI:2.88-38.66), had 6-10 male anal sex partners in the past 6 months (OR=4.90;CI:1.56-15.40) were significantly likely to had actual uptake of PrEP. (Table 4).
3.3 The barriers of MSM with objective need of PrEP for HIV prevention
The participants who they had objective need to use PrEP for HIV prevention are the population that this study focus on. Therefore, we investigated the subjective and objective barriers of them to use PrEP for HIV prevention. Of the 62 participants who had objective need but unwillingness to use PrEP, the reasons were summarized as below: 40 (64.52%) were concerned about the drug side-effect; 34 (54.84%) don't know where to get medicine; 30 (48.39%) believe the occurrence of high-risk behavior is unpredictable; 21 (33.87%) had pill fatigue and 11 (17.74%) sense of shame; 12 (19.35%) had fluke mind which they were less likely to contract HIV, and 6 (9.68%) had pressure from sexual partners. Of the 450 participants who failure to obtain PrEP but with willingness, the reasons were summarized as below: 352 (78.22%) considered the cost of PrEP is too high; 172 (38.22%) worried long distances for drug delivery; 150 (33.33%) reported that medical institutions are not in working hours when needed, and 42 (9.33%) were previously rejected by medical institution.