Lim Sin How, Mburu Gitau, Bourne Adam, Pang Joselyn, Wickersham Jeffrey A, Wei Clayton Koh Thuan, Yee Ilias Adam, Wang Bangyuan, Cassolato Matteo, Azwa Iskandar
Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Division of Health Research, University of Lancaster, United Kingdom.
PLoS One. 2017 Sep 13;12(9):e0182838. doi: 10.1371/journal.pone.0182838. eCollection 2017.
We examined willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia.
An online survey of 990 MSM was conducted between March and April 2016. Eligibility criteria included being biological male, Malaysian citizen, 18 years of age or above, identifying as MSM, and being HIV negative or unknown status. Participants' demographics, sexual and drug use behaviors, attitudes towards PrEP, and preferences regarding future access to PrEP were collected. Bivariate analysis and logistic regression were performed to determine factors associated with willingness to use PrEP.
Fewer than half of participants (44%) knew about PrEP before completing the survey. Overall, 39% of the sample were willing to take PrEP. Multivariate logistic regression indicated that Malay men (AOR: 1.73, 95% CI:1.12, 2.70), having 2 or more male anal sex partners in the past 6 months (AOR: 1.98, 95% CI: 1.29, 3.05), previous knowledge of PrEP (AOR: 1.40, 95%CI: 1.06, 1.86), lack of confidence in practising safer sex (AOR: 1.36, 95% CI: 1.02, 1.81), and having ever paid for sex with a male partner (AOR: 1.39, 95% CI: 1.01, 1.91) were independently associated with greater willingness to use PrEP, while men who identified as heterosexual were less willing to use PrEP (AOR, 0.36, 95% CI: 0.13, 0.97). Majority of participants preferred to access PrEP at affordable cost below 100 Malaysian Ringgit (USD25) per month from community based organisations followed by private or government hospitals.
Overall, MSM in Malaysia reported a relatively low level of willingness to use PrEP, although willingness was higher among those previously aware of PrEP. There is a need to provide PrEP at affordable cost, increase demand and awareness of PrEP, and to provide access to this preventative medication via diverse, integrated and tailored sexual health services.
我们调查了马来西亚男男性行为者（MSM）使用暴露前预防（PrEP）进行HIV预防的意愿。
2016年3月至4月对990名男男性行为者进行了在线调查。纳入标准包括生物学男性、马来西亚公民、18岁及以上、自我认同为男男性行为者，以及HIV阴性或感染状况未知。收集了参与者的人口统计学信息、性和药物使用行为、对PrEP的态度以及未来获取PrEP的偏好。进行了双变量分析和逻辑回归以确定与使用PrEP意愿相关的因素。
不到一半的参与者（44%）在完成调查前知晓PrEP。总体而言，39%的样本愿意服用PrEP。多变量逻辑回归表明，马来男性（优势比：1.73，95%置信区间：1.12，2.70）、在过去6个月内有2个或更多男性肛交性伴侣（优势比：1.98，95%置信区间：1.29，3.05）、之前知晓PrEP（优势比：1.40，95%置信区间：1.06，1.86）、对实施安全性行为缺乏信心（优势比：1.36，95%置信区间：1.02，1.81）以及曾与男性伴侣有偿性行为（优势比：1.39，95%置信区间：1.01，1.91）与更愿意使用PrEP独立相关，而自我认同为异性恋的男性更不愿意使用PrEP（优势比，0.36，95%置信区间：0.13，0.97）。大多数参与者更倾向于以每月低于100马来西亚林吉特（25美元）的可承受成本从社区组织获取PrEP，其次是私立或政府医院。
总体而言，马来西亚的男男性行为者报告使用PrEP的意愿相对较低，尽管之前知晓PrEP的人意愿较高。有必要以可承受的成本提供PrEP，增加对PrEP的需求和认识，并通过多样化、综合和量身定制的性健康服务提供这种预防性药物。
