Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, US.
Tokyo College, the University of Tokyo, Tokyo, Japan.
Int J Behav Med. 2024 Apr;31(2):252-262. doi: 10.1007/s12529-023-10177-y. Epub 2023 May 8.
Oral pre-exposure prophylaxis (PrEP) as a safe and effective antiretroviral medicine-based prevention against HIV has not been widely adopted by gay, bisexual, and other men who have sex with men (MSM) in China. A deeper understanding of barriers and facilitators to PrEP uptake is needed to inform the development of effective interventions.
During July-August 2020, we conducted one-on-one semi-structured interviews with 31 Chinese MSM with varied PrEP use experiences (PrEP-naïve, former, and current PrEP users). Interviews were digitally recorded and transcribed in Chinese. Informed by the Information-Motivation-Behavioral Skills Model (IMB), we analyzed the data using a thematic analysis approach to identify the barriers and facilitators to PrEP uptake among Chinese MSM.
Major barriers to PrEP uptake among MSM in the sample included uncertainty about PrEP efficacy and lack of PrEP education (information), concerns over potential side effects and cost (motivation), and difficulties in identifying authentic PrEP medications and managing PrEP care (behavioral skills). Facilitators include the perceived benefit of PrEP in improving the quality of sex life and control over health. At the contextual level, we also identified barriers to PrEP access from a thriving informal PrEP market and stressors related to being MSM.
Our findings identified a need to invest in non-discriminatory public health messaging of PrEP, explore options for MSM-friendly provision of PrEP outside of traditional HIV care settings, and be attentive to the unique context of an established informal PrEP market in future PrEP initiatives.
口腔暴露前预防（PrEP）作为一种安全有效的基于抗逆转录病毒药物的艾滋病预防方法，尚未在中国得到广泛采用，包括男同性恋、双性恋和其他与男性发生性关系的男性（MSM）群体。为了制定有效的干预措施，需要深入了解 PrEP 采用的障碍和促进因素。
2020 年 7 月至 8 月，我们对 31 名具有不同 PrEP 使用经验（PrEP 初治、既往和当前 PrEP 用户）的中国 MSM 进行了一对一的半结构式访谈。访谈以中文进行数字记录和转录。根据信息-动机-行为技能模型（IMB），我们采用主题分析方法对数据进行分析，以确定中国 MSM 采用 PrEP 的障碍和促进因素。
该样本中 MSM 采用 PrEP 的主要障碍包括对 PrEP 疗效的不确定性和缺乏 PrEP 教育（信息）、对潜在副作用和成本的担忧（动机）以及难以识别真实的 PrEP 药物和管理 PrEP 护理（行为技能）。促进因素包括 PrEP 在改善性生活质量和控制健康方面的益处。在背景层面，我们还从活跃的非正式 PrEP 市场和与 MSM 相关的压力源方面确定了 PrEP 可及性的障碍。
我们的研究结果表明，需要投资于非歧视性的 PrEP 公共卫生宣传，探索在传统 HIV 护理环境之外为 MSM 提供友好的 PrEP 选择，并在未来的 PrEP 倡议中关注已建立的非正式 PrEP 市场的独特背景。
