中国男男性行为者（MSM）对暴露前预防（PrEP）的支付意愿较低。
Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China.
机构信息
School of Public Health, Brown University, Providence, RI, USA.
School of Public Health, Sun Yat-sen University, Guangzhou, China.
出版信息
BMC Public Health. 2020 Mar 16;20(1):337. doi: 10.1186/s12889-020-08488-w.
BACKGROUND
Pre-exposure prophylaxis (PrEP) is recommended as an HIV prevention strategy for key populations, in particular men who have sex with men (MSM). However, the willingness to pay market rate for PrEP is largely unknown. This study aimed to investigate the willingness to pay for PrEP and its associated factors among MSM living in Mainland China.
METHODS
A cross-sectional survey was conducted among 689 MSM who were recruited through a gay-friendly health consulting service center in Chengdu, China during 2018-2019. We collected information on participants' willingness to pay for PrEP and its potential correlates (e.g., PrEP awareness and acceptability, perceived risk of HIV infection) using a structured questionnaire. Univariate and multivariate logistic regression were used for data analyses.
RESULTS
Only 14.1% of respondents indicated they would not pay any money for PrEP, around half (49.3%) would like to pay $14-84 per month, and very few (6.8%) would like to pay ≥283 per month (market rate). We found that PrEP awareness (unadjusted odds ratio (ORu) = 1.41; 95% CI: 1.01-1.97), acceptability (ORu =1.20; 95% CI: 1.07-1.34), perceived PrEP adherence (ORu =1.23; 95% CI: 1.08-1.41), and perceived PrEP benefit in reducing condom use (ORu =1.29; 95% CI: 1.07-1.55) were all associated with participants' willingness to pay the market rate for PrEP. Other facilitators of PrEP pay willingness included full disclosure of sexual orientation to health professionals, high HIV literacy, and a high degree of HIV disclosure with sex partners.
CONCLUSIONS
The overall willingness to pay for the market rate of PrEP was low among this urban sample of Chinese MSM. Programs aiming to promote PrEP pay willingness should provide enhanced counseling to improve PrEP-related cognition, deliver accurate HIV/PrEP information to increase health literacy, and decrease stigma towards sexual minorities to develop trust with health professionals.
背景
暴露前预防（PrEP）被推荐作为一种艾滋病毒预防策略，适用于关键人群，特别是男男性行为者（MSM）。然而，对于 PrEP 的市场意愿支付率在很大程度上是未知的。本研究旨在调查中国内地 MSM 对 PrEP 的支付意愿及其相关因素。
方法
2018-2019 年，我们通过在中国成都的一家同性恋友好健康咨询服务中心，对 689 名 MSM 进行了横断面调查。我们使用结构化问卷收集了参与者对 PrEP 的支付意愿及其潜在相关因素（如 PrEP 意识和可接受性、艾滋病毒感染的感知风险）的信息。采用单变量和多变量逻辑回归进行数据分析。
结果
只有 14.1%的受访者表示他们不会为 PrEP 支付任何费用，大约一半（49.3%）愿意每月支付 14-84 美元，极少数（6.8%）愿意每月支付≥283 美元（市场价格）。我们发现，PrEP 意识（未调整的优势比（ORu）=1.41；95%可信区间：1.01-1.97）、可接受性（ORu=1.20；95%可信区间：1.07-1.34）、感知 PrEP 依从性（ORu=1.23；95%可信区间：1.08-1.41）和感知 PrEP 在减少安全套使用方面的益处（ORu=1.29；95%可信区间：1.07-1.55）均与参与者愿意支付 PrEP 的市场价格有关。促进 PrEP 支付意愿的其他促进因素包括向卫生专业人员充分披露性取向、较高的艾滋病毒知识水平以及与性伴侣进行较高程度的艾滋病毒披露。
结论
在本研究的中国城市 MSM 样本中，对 PrEP 的市场价格的总体支付意愿较低。旨在提高 PrEP 支付意愿的项目应提供强化咨询，以提高与 PrEP 相关的认知，提供准确的艾滋病毒/PrEP 信息以提高健康素养，并减少对性少数群体的污名化，以与卫生专业人员建立信任。
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