Draper Bridget L, Fowkes Freya J I, Oo Zaw Min, Thein Zaw Win, Aung Poe Poe, Veronese Vanessa, Ryan Claire, Thant Myo, Hughes Chad, Stoové Mark
Department of Disease Elimination, Burnet Institute, Melbourne, Australia.
Department of International Development, Burnet Institute, Yangon, Myanmar.
J Int AIDS Soc. 2017 Jul 26;20(1):21885. doi: 10.7448/IAS.20.1.21885.
HIV pre-exposure prophylaxis (PrEP) has emerged as a key component of contemporary HIV combination prevention strategies. To explore the local suitability of PrEP, country-specific acceptability studies are needed to inform potential PrEP implementation. In the context of Myanmar, in addition to resource constraints, HIV service access by gay men, other men who have sex with men, and transgender women (GMT) continues to be constrained by legislative and community stigma and marginalization. We aimed to determine PrEP acceptability among GMT in Myanmar and explore the factors associated with willingness to use PrEP.
GMT were recruited in Yangon and Mandalay through local HIV prevention outreach programmes in November and December 2014. Quantitative surveys were administered by trained peer educators and collected data on demographics, sexual risk, testing history and PrEP acceptability. A modified six-item PrEP acceptability scale classified self-reported HIV undiagnosed GMT as willing to use PrEP. Multivariable logistic regression identified factors associated with willingness to use PrEP.
Among 434 HIV undiagnosed GMT, PrEP awareness was low (5%). PrEP acceptability was high, with 270 (62%) GMT classified as willing to use PrEP. GMT recruited in Mandalay (adjusted odds ratio (aOR) = 1.79; 95%CI = 1.05-3.03), who perceived themselves as likely to become HIV positive (aOR = 1.82; 95%CI = 1.10-3.02), who had more than one recent regular partner (aOR = 2.94; 95%CI = 1.41-6.14), no regular partners (aOR = 2.05; 95%CI = 1.10-3.67), more than five casual partners (aOR = 2.05; 95%CI = 1.06-3.99) or no casual partners (aOR = 2.25; 95%CI = 1.23-4.11) were more likely to be willing to use PrEP. The association between never or only occasionally using condoms with casual partners and willingness to use PrEP was marginally significant (aOR = 2.02; 95%CI = 1.00-4.10). GMT who reported concern about side effects and long-term use of PrEP were less likely (aOR = 0.35; 95%CI = 0.21-0.59) to be willing to use PrEP.
This is the first study to assess PrEP acceptability in Myanmar. Findings suggest PrEP is an acceptable prevention option among GMT in Myanmar, providing they are not required to pay for it. Implementation/demonstration projects are needed to explore the feasibility and cost-effectiveness of PrEP as a prevention option for GMT in Myanmar.
艾滋病毒暴露前预防（PrEP）已成为当代艾滋病毒综合预防策略的关键组成部分。为探索PrEP在当地的适用性，需要开展针对特定国家的可接受性研究，以为PrEP的潜在实施提供参考依据。在缅甸，除资源限制外，男同性恋者、其他男男性行为者以及变性女性（GMT）获取艾滋病毒服务仍受到法律和社区耻辱感及边缘化的制约。我们旨在确定缅甸GMT群体对PrEP的可接受性，并探索与使用PrEP意愿相关的因素。
2014年11月和12月，通过仰光和曼德勒当地的艾滋病毒预防外展项目招募GMT群体。由经过培训的同伴教育者进行定量调查，收集有关人口统计学、性风险、检测史和PrEP可接受性的数据。一个经过修改的六项PrEP可接受性量表将自我报告未感染艾滋病毒的GMT群体归类为愿意使用PrEP。多变量逻辑回归确定了与使用PrEP意愿相关的因素。
在434名未感染艾滋病毒的GMT群体中，对PrEP的知晓率较低（5%）。PrEP的可接受性较高，270名（62%）GMT群体被归类为愿意使用PrEP。在曼德勒招募的GMT群体（调整后的优势比（aOR）=1.79；95%置信区间（CI）=1.05 - 3.03）、认为自己有可能感染艾滋病毒的群体（aOR = 1.82；95%CI = 1.10 - 3.02）、近期有不止一个固定性伴侣的群体（aOR = 2.94；95%CI = 1.41 - 6.14）、没有固定性伴侣的群体（aOR = 2.05；95%CI = 1.10 - 3.67）、有超过五个临时性伴侣的群体（aOR = 2.05；95%CI = 1.06 - 3.99）或没有临时性伴侣的群体（aOR = 2.25；95%CI = 1.23 - 4.11）更有可能愿意使用PrEP。与临时性伴侣从不或仅偶尔使用避孕套和使用PrEP意愿之间的关联具有边缘显著性（aOR = 2.02；95%CI = 1.00 - 4.10）。报告担心PrEP副作用和长期使用的GMT群体愿意使用PrEP的可能性较小（aOR = 0.35；95%CI = 0.21 - 0.59）。
这是第一项评估缅甸PrEP可接受性的研究。研究结果表明，在缅甸的GMT群体中，PrEP是一种可接受的预防选择，前提是无需他们付费。需要开展实施/示范项目，以探索PrEP作为缅甸GMT群体预防选择的可行性和成本效益。
