中国成都男男性行为人群HIV暴露前预防用药行为-认知偏差现状及其影响因素

doi:10.19723/j.issn.1671-167X.2023.03.018

Abstract

Abstract:

Objective: To explore the discrepancy between behavioral-indicated candidacy and perceived candidacy (behavioral-perceived gap) and its associated factors of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM), so as to identify the focus population of PrEP interventions and to design and implement targeted interventions. Methods: We recruited a sample of 622 HIV-negative MSM who were regular clients of a community-based organization located in Chengdu, China, from November to December 2021. A cross-sectional questionnaire was used to collect the participants' information on social demographics, PrEP-related knowledge and cognitions, and risk behaviors. In this study, behaviorally eligible for PrEP was defined as performing at least one type of high-risk behavior in the past six months, including inconsistent condom use, sex with an HIV-positive partner, confirmed sexual transmitted infections (STI) diagnosis, substance use, and post-exposure prophylaxis (PEP) experience. Logistic regression models were fitted, and multivariate analyses were adjusted for social demographics. Results: Among the 622 eligible participants, 52.6% (327/622) were classified as behaviorally eligible for PrEP. Only 37.9% (124/327) of the participants perceived themselves as appropriate candidates for PrEP and 62.1% (203/207) had discrepancy between behavioral-indicated and perceived candidacy. 85.9% (281/327) had heard of PrEP, and 14.2% (40/281) accessed PrEP information through health care providers. Of the 327 participants eligible for behavior-indicated PrEP use, about half (47.1%) knew how to obtain PrEP medication and 33.0% had a professional PrEP counseling experience. The majority (93.3%) had no or few friends using PrEP. 54.1% scored eight or above in PrEP knowledge level. 66.7% reported having two or more sexual partners in the past six months. After adjusting for age and recruitment channel, we found six factors that were associated with perceived candidacy for PrEP, including PEP use [adjusted odds ratio (OR_A)=2.20; 95% confidence interval (CI): 1.33-3.63], PrEP availability (OR_A=1.69; 95%CI: 1.06-2.68), a greater number of PrEP-using friends (OR_A=4.92; 95%CI: 1.77-13.65), PrEP know-ledge (OR_A=2.21; 95%CI: 1.38-3.56), multiple sexual partnership (OR_A=1.77; 95%CI: 1.07-2.94), and perceiving a higher risk of HIV infection (OR_A=4.02; 95%CI: 1.73-9.32). Substance use during sex and PrEP information channel were not statistically associated with this beha-vioral-perceived gap. Conclusion: We observed a high discrepancy between behavioral-indicated and perceived candidacy for PrEP among Chengdu MSM in China. Future PrEP implementation efforts should be made in skills training in assessing HIV infection risk, increasing PrEP knowledge, providing professional PrEP counselling, and fostering PrEP support environment.

Key words: Homosexuality, male, Sexual behavior, Pre-exposure prophylaxis, HIV infections, Cognitive dissonance, Risk perception

CLC Number:

R167

Hao LIN,Jing-hua LI,Xiao YANG,Xiao-ting CHEN,Yu-hui SHI,Chun CHANG,Yuan-tao HAO,Wang-nan CAO. Discrepancy between behavioral-indicated and perceived candidacy for HIV pre-exposure prophylaxis among men who have sex with men in Chengdu, China[J].Journal of Peking University (Health Sciences), 2023, 55(3): 511-520.

Figures/Tables 4

Table 1

Table 2

Characteristics related to PrEP and sexual behavior among behavioral-indicated PrEP eligible participants"

Items	Total (n=327)	No behavioral-perceived gap (n=124)	Behavioral-perceived gap (n=203)
Any condomless anal intercourse
No	151 (46.2)	61 (49.2)	90 (44.3)
Yes	176 (53.8)	63 (50.8)	113 (55.7)
Have HIV-positive partner(s)
No	298 (91.1)	115 (92.7)	183 (90.1)
Yes	29 (8.9)	9 (7.3)	20 (9.9)
Ever STI diagnosis
No	303 (92.7)	118 (95.2)	185 (91.1)
Yes	24 (7.3)	6 (4.8)	18 (8.9)
Substance use
No	206 (63.0)	70 (56.5)	136 (67.0)
Yes	121 (37.0)	54 (43.5)	67 (33.0)
PEP user
No	231 (70.6)	76 (61.3)	155 (76.4)
Yes	96 (29.4)	48 (38.7)	48 (23.6)
PrEP awareness
No	46 (14.1)	15 (12.1)	31 (15.3)
Yes	281 (85.9)	109 (87.9)	172 (84.7)
Sources of PrEP information
Others	241 (85.8)	104 (83.9)	183 (90.1)
HCP	40 (14.2)	20 (16.1)	20 (9.9)
PrEP availability
No	173 (52.9)	58 (46.8)	115 (56.7)
Yes	154 (47.1)	66 (53.2)	88 (43.3)
PrEP counseling experience with HCP
No	219 (67.0)	79 (63.7)	140 (69.0)
Yes	108 (33.0)	45 (36.3)	63 (31.0)
Peers who are on PrEP
Many	22 (6.7)	15 (12.1)	7 (3.4)
Few	166 (50.8)	59 (47.6)	107 (52.7)
None	139 (42.5)	50 (40.3)	89 (43.8)
PrEP knowledge score^a
≤7	155 (45.9)	41 (33.1)	109 (53.7)
>7	177 (54.1)	83 (66.9)	94 (46.3)
Sexual role^b
Insertive	104 (31.8)	33 (26.6)	71 (35.0)
Receptive	100 (30.6)	42 (33.9)	58 (28.6)
Both	107 (32.7)	44 (35.5)	63 (31.0)
No anal sex	16 (4.9)	5 (4.0)	11 (5.4)
Multiple homosexual partnership^b
No	109 (33.3)	33 (26.6)	76 (37.4)
Yes	218 (66.7)	91 (73.4)	127 (62.6)
Engagement in group sex^b
No	189 (57.8)	82 (90.1)	107 (84.3)
Yes	29 (8.9)	9 (9.9)	20 (15.7)
Engagement in transactional sex^b
No	288(88.1)	112 (90.3)	176 (86.7)
Yes	39 (11.9)	12 (9.7)	27 (13.3)
HIV test history^b
No	82 (25.1)	33 (26.6)	49 (24.1)
Yes	245 (74.9)	91 (73.4)	154 (75.9)
Perceived risk of HIV infection^c
High-risk	29 (8.9)	18 (14.5)	11 (5.4)
Medium-risk	85 (26.0)	34 (27.4)	51 (25.1)
Low-risk	213 (65.1)	72 (58.1)	141 (69.5)

Table 2

Table 3

Table 4

Univariate analysis on factors associated with perceived PrEP candidacy"

Items	Row%	OR_u (95%CI)	OR_A (95%CI)^a
Any condomless anal intercourse
No	40.4	1	1
Yes	35.8	0.82 (0.53-1.29)	0.87 (0.55-1.37)
Have HIV-positive partner(s)
No	38.6	1	1
Yes	31	0.72 (0.32-1.63)	0.79 (0.33-1.87)
Ever STI diagnosis
No	38.9	1	1
Yes	25	0.52 (0.20-1.35)	0.71 (0.26-1.93)
Substance use
No	34	1	1
Yes	44.6	1.57 (0.99-2.48)	1.42 (0.88-2.29)
PEP user
No	32.9	1	1
Yes	50	2.04 (1.26-3.31)^**	2.20 (1.33-3.63)^**
PrEP awareness
No	32.6	1	1
Yes	38.8	1.31 (0.68-2.54)	1.29 (9.66-2.51)
Sources of PrEP information
Others	36.2	1	1
HCP	50	1.76 (0.91-3.42)	1.60 (0.82-3.15)
PrEP availability
No	33.5	1	1
Yes	42.9	1.49 (0.95-2.33)	1.69 (1.06-2.68)^*
PrEP counseling experience with HCP
No	36.1	1	1
Yes	41.7	1.27 (0.79-2.03)	1.43 (0.88-2.32)
Peers who are on PrEP
None	36	1	1
Few	35.5	0.98 (0.61-1.57)	1.05 (0.65-1.70)
Many	68.2	3.81 (1.46-9.98)^**	4.92 (1.77-13.65)^**
PrEP knowledge score (total 9)
≤7	27.3	1	1
>7	46.9	2.35 (1.48-3.74)^***	2.21 (1.38-3.56)^**
Sexual role^b
Insertive	31.7	1	1
Receptive	42	1.56 (0.88-2.76)	1.58 (0.88-2.83)
Both	41.1	1.50 (0.85-2.64)	1.45 (0.82-2.56)
No anal sex	31.3	0.98 (0.31-3.04)	0.92 (0.29-2.92)
Multiple homosexual partnership^b
No	30.3	1	1
Yes	41.7	1.65 (1.01-2.69)^*	1.77 (1.07-2.94)^*
Engagement in group sex^b
No	43.4	1	1
Yes	31	0.59 (0.25-1.36)	0.64 (0.27-1.51)
Engagement in transactional sex^b
No	38.9	1	1
Yes	30.8	0.70 (0.34-1.44)	0.71 (0.34-1.51)
HIV test history^b
No	40.2	1	1
Yes	37.1	0.88 (0.53-1.46)	0.89 (0.53-1.49)
Perceived risk of HIV infection^c
Low-risk	33.8	1.00	1.00
Medium-risk	40.0	1.31 (0.78-2.19)	1.35 (0.79-2.29)
High-risk	62.1	3.21 (1.44-7.15)^**	4.02 (1.73-9.32)^**

Table 4

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Items	Total (n=327)	No behavioral-perceived gap (n=124)	Behavioral-perceived gap (n=203)
Recruitment channel
MSM activity venues	52 (15.9)	13 (10.5)	39 (19.2)
MSM peer network	169 (51.7)	70 (56.5)	99 (48.8)
MSM community organization	106 (32.4)	41 (33.1)	65 (32.0)
Age
18-24 years	92 (28.1)	34 (27.4)	58 (28.6)
25-35 years	165 (50.5)	69 (55.6)	96 (47.3)
>35 years	70 (21.4)	21 (16.9)	49 (24.1)
Current relationship status
Single	48 (14.7)	21 (16.9)	27 (13.3)
Relationship with a man	246 (75.2)	88 (71.0)	158 (77.8)
Married	33 (10.1)	15 (12.1)	18 (8.9)
Education level
College degree and below	176 (53.8)	62 (50.0)	114 (56.2)
Undergraduate and above	151 (46.2)	62 (50.0)	89 (43.8)
Employment status
Unemployed/part-time/retired/student	107 (32.7)	38 (30.6)	69 (34.0)
Full-time	220 (67.3)	86 (69.4)	134 (66.0)
Personal monthly income
≤4 000 yuan	111 (33.9)	42 (33.9)	69 (34.0)
4 001-6 000 yuan	107 (32.7)	45 (36.3)	62 (30.5)
6 001-8 000 yuan	109 (33.3)	37 (29.8)	72 (35.5)
Sexual orientation
Homosexual	274 (83.8)	106 (85.5)	168 (82.8)
Bisexual/heterosexual/other	53 (16.2)	18 (14.5)	35 (17.2)

Items	Row%	OR_u (95%CI)
Recruitment channel
MSM activity venues	25.0	1.00
MSM peer network	41.4	2.12 (1.06-4.27)^*
MSM community organization	38.7	1.89 (0.90-3.96)^?
Age
18-24 years	37.0	1.37 (0.70-2.66)
25-35 years	41.8	1.68(0.92-3.05)^?
>35 years	30.0	1.00
Current relationship status
Single	43.8	1.00
Relationship with a man	35.8	0.72 (0.38-1.34)
Married	45.5	1.07 (0.44-2.61)
Education level
College degree and below	35.2	1.00
Undergraduate and above	41.1	1.28 (0.82-2.01)
Employment status
Unemployed/part-time/retired/student	35.5	1.00
Full-time	39.1	1.17 (0.72-1.88)
Personal monthly income
≤4 000 yuan	37.8	1.00
4 001-6 000 yuan	42.1	1.19 (0.69-2.05)
6 001-8 000 yuan	33.9	0.84 (0.49-1.47)
Sexual orientation
Homosexual	38.7	1.00
Bisexual/heterosexual/other	34.0	0.82 (0.44-1.51)

Discrepancy between behavioral-indicated and perceived candidacy for HIV pre-exposure prophylaxis among men who have sex with men in Chengdu, China

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