Factors influencing uptake of pre-exposure prophylaxis: some qualitative insights from an intervention study of men who have sex with men in China
Chunxing Liu A * , Yingying Ding A * , Zhen Ning B , Meiyang Gao A , Xing Liu A , Frank Y. Wong A C and Na He A D E
+ Author Affiliations
- Author Affiliations
A Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai 200032, China.
B Shanghai Center for Disease Control and Prevention, Shanghai 200336, China.
C Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96813, USA
D Collaborative Innovation Centre of Social Risks Governance in Health, Fudan University, Shanghai 200032, China.
E Corresponding author. Email: nhe@fudan.edu.cn
Sexual Health 15(1) 39-45 https://doi.org/10.1071/SH17075
Submitted: 7 April 2017 Accepted: 2 July 2017 Published: 1 September 2017
Abstract
Background: Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. However, its uptake among men who have sex with men (MSM) is low in China. The study aimed to identify factors that might influence MSM’s uptake and use of PrEP. Methods: In-depth interviews were conducted with 32 self-identified MSM from a PrEP intervention study evaluating daily oral tenofovir disoproxil fumarate (TDF) to prevent HIV infection. Of these men, 11 were presently using the ‘TDF’ group; 8 from the ‘change-over’ group (i.e. initially used PrEP but subsequently quitted); and 13 from the non-user group. Data were analysed using thematic approach. Results: Perception of low HIV risk, mistrust of the national PrEP program, and concerns of side effects were the main reasons for not wanting to use PrEP. Also, lack of main sexual partner’s support, difficulties in adhering to the daily TDF regimen, and the inconvenient schedules in securing the medicine were the major reasons for not wanting to use or quitting the use of PrEP. On the other hand, perceived high HIV risk, beliefs in efficacy of PrEP, and worries of transmitting HIV to families were the major motives for PrEP uptake. Conclusions: Findings suggest that PrEP implementation strategies should first address issues including but not limited to accurate self-assessment of HIV risk, mistrust and limited knowledge about medical trials and PrEP, and ease of accessing PrEP.
Additional keywords: tenofovir disoproxil fumarate, biomedical approach, HIV prevention.
References
[1] Tang S, Tang W, Meyers K, Chan P, Chen Z, Tucker JD. HIV and syphilis among men who have sex with men and transgender individuals in China: a scoping review. Lancet 2016; 388 S74| HIV and syphilis among men who have sex with men and transgender individuals in China: a scoping review.Crossref | GoogleScholarGoogle Scholar |
[2] National Health and Family Planning Commission of The People’s Republic of China. China AIDS Response Progress Report. Beijing; National Health and Family Planning Commission of the People’s Republic of China; 2015.
[3] Reyniers T, Hoornenborg E, Vuylsteke B, Wouters K, Laga M. Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool. Sex Transm Infect 2017; 93 363–67.
| Pre-exposure prophylaxis (PrEP) for men who have sex with men in Europe: review of evidence for a much needed prevention tool.Crossref | GoogleScholarGoogle Scholar |
[4] Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, Rodolph M, Hodges-Mameletzis I, Grant RM. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS 2016; 30 1973–83.
| Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.Crossref | GoogleScholarGoogle Scholar |
[5] Baeten JM, Donnell D, Mugo NR, Ndase P, Thomas KK, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kidoguchi L, Coombs RW, Hendrix C, Marzinke MA, Frenkel L, Haberer JE, Bangsberg D, Celum C. Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial. Lancet Infect Dis 2014; 14 1055–64.
| Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC2cXhslagsbzF&md5=3e83404b5e65e7f847ef664772b69919CAS |
[6] Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, Chiamwongpaet S, Kitisin P, Natrujirote P, Kittimunkong S, et al Bangkok Tenofovir Study Group Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2013; 381 2083–90.
| Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial.Crossref | GoogleScholarGoogle Scholar |
[7] Wei S, Zhang H, Wang J, Song D, Duan Y, Yu F, She M, Wang M, Zhang H. HIV and syphilis prevalence and associated factors among young men who have sex with men in 4 cities in China. AIDS Behav 2013; 17 1151–8.
| HIV and syphilis prevalence and associated factors among young men who have sex with men in 4 cities in China.Crossref | GoogleScholarGoogle Scholar |
[8] Zhang Y, Peng B, She Y, Liang H, Peng HB, Qian HZ, Vermund SH, Zhong XN, Huang A. Attitudes toward HIV pre-exposure prophylaxis among men who have sex with men in western China. AIDS Patient Care STDS 2013; 27 137–41.
| Attitudes toward HIV pre-exposure prophylaxis among men who have sex with men in western China.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XptFGju7s%3D&md5=309f4b052bc5c4ccc48168e8da698352CAS |
[9] Ding Y, Yan H, Ning Z, Cai X, Yang Y, Pan R, Zhou Y, Zheng H, Gao M, Rou K, Wu Z, He N. Low willingness and actual uptake of pre-exposure prophylaxis for HIV-1 prevention among men who have sex with men in Shanghai, China. Biosci Trends 2016; 10 113–9.
| Low willingness and actual uptake of pre-exposure prophylaxis for HIV-1 prevention among men who have sex with men in Shanghai, China.Crossref | GoogleScholarGoogle Scholar |
[10] Krakower DS, Mimiaga MJ, Rosenberger JG, Novak DS, Mitty JA, White JM, Mayer KH. Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an Internet Social Networking Site. PLoS One 2012; 7 e33119
| Limited awareness and low immediate uptake of pre-exposure prophylaxis among men who have sex with men using an Internet Social Networking Site.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XlsVagt7s%3D&md5=f8d5c5d4d76fb99c55e941293305cf3cCAS |
[11] Chakrapani V, Newman PA, Shunmugam M, Mengle S, Varghese J, Nelson R, Bharat S. Acceptability of HIV pre-exposure prophylaxis (PrEP) and implementation challenges among men who have sex with men in India: a qualitative investigation. AIDS Patient Care STDS 2015; 29 569–77.
| Acceptability of HIV pre-exposure prophylaxis (PrEP) and implementation challenges among men who have sex with men in India: a qualitative investigation.Crossref | GoogleScholarGoogle Scholar |
[12] Mimiaga MJ, Closson EF, Kothary V, Mitty JA. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men. Arch Sex Behav 2014; 43 99–106.
| Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[13] Wade Taylor S, Mayer KH, Elsesser SM, Mimiaga MJ, O’Cleirigh C, Safren SA. Optimizing content for pre-exposure prophylaxis (PrEP) counseling for men who have sex with men: perspectives of PrEP users and high-risk PrEP naive men. AIDS Behav 2014; 18 871–9.
| Optimizing content for pre-exposure prophylaxis (PrEP) counseling for men who have sex with men: perspectives of PrEP users and high-risk PrEP naive men.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2c%2FitFCluw%3D%3D&md5=3bb5badc3890f358b6ace938acd800a4CAS |
[14] Young I, Flowers P, McDaid LM. Barriers to uptake and use of pre-exposure prophylaxis (PrEP) among communities most affected by HIV in the UK: findings from a qualitative study in Scotland. BMJ Open 2014; 4 e005717
| Barriers to uptake and use of pre-exposure prophylaxis (PrEP) among communities most affected by HIV in the UK: findings from a qualitative study in Scotland.Crossref | GoogleScholarGoogle Scholar |
[15] Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDS 2015; 29 102–10.
| Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV.Crossref | GoogleScholarGoogle Scholar |
[16] Eaton EA, Driffin DD, Smith H, Conway-Washington C, White D, Cherry C. Psycho-social factors related to willingness to use pre-exposure prophylaxis for HIV prevention among black men who have sex with men attending a community event. Sex Health 2014; 11 244–51.
| Psycho-social factors related to willingness to use pre-exposure prophylaxis for HIV prevention among black men who have sex with men attending a community event.Crossref | GoogleScholarGoogle Scholar |
[17] Underhill K, Morrow KM, Colleran C, Holcomb R, Calabrese SK, Operario D, Galárraga O, Mayer KH. A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by U.S. male sex workers and other men who have sex with men: implications for biomedical HIV prevention. J Urban Health 2015; 92 667–86.
| A qualitative study of medical mistrust, perceived discrimination, and risk behavior disclosure to clinicians by U.S. male sex workers and other men who have sex with men: implications for biomedical HIV prevention.Crossref | GoogleScholarGoogle Scholar |
[18] Galindo GR, Walker JJ, Hazelton P, Lane T, Steward WT, Morin SF, Arnold EA. Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation. Implement Sci 2012; 7 116
| Community member perspectives from transgender women and men who have sex with men on pre-exposure prophylaxis as an HIV prevention strategy: implications for implementation.Crossref | GoogleScholarGoogle Scholar |
[19] Young I, Flowers P, McDaid LM. Key factors in the acceptability of treatment as prevention (TasP) in Scotland: a qualitative study with communities affected by HIV. Sex Transm Infect 2015; 91 269–74.
| Key factors in the acceptability of treatment as prevention (TasP) in Scotland: a qualitative study with communities affected by HIV.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MzlvFOhtg%3D%3D&md5=c5a904e06d7b96f599b6bd26e29e35f4CAS |
[20] Ma W, Ding X, Lu H, Ma X, Xia D, Lu R, Xu J, He X, Feng L, Fan S, Sun J, Wilson EC, Raymond HF, McFarland W, Jia Y, Shao Y, Xiao Y, Ruan Y. HIV risk perception among men who have sex with men in two municipalities of China-implications for education and intervention. AIDS Care 2013; 25 385–9.
[21] Beymer MR, Weiss RE, Sugar CA, Bourque LB, Gee GC, Morisky DE, Shu SB, Javanbakht M, Bolan RK. Are centers for disease control and prevention guidelines for preexposure prophylaxis specific enough? Formulation of a personalized HIV risk score for pre-exposure prophylaxis initiation. Sex Transm Dis 2017; 44 49–57.
| Are centers for disease control and prevention guidelines for preexposure prophylaxis specific enough? Formulation of a personalized HIV risk score for pre-exposure prophylaxis initiation.Crossref | GoogleScholarGoogle Scholar |
[22] Oldenburg CE Le B Huyen HT Thien DD Quan NH Biello KB Nunn A Chan PA Mayer KH Mimiaga MJ Colby D
[23] Ho YFD, Chiu CY. Component idea of individualism, collectivism and social organization. An application in the study of Chinese culture. In Kim U, Triandis CH, Kagitcibasi C, Choi S-C, Yoon G, editors. Individualism and collectivism: theory, method and applications. Thousand Oaks, CA: Sage Publication; 1994. pp. 137–56.
[24] Liu H, Feng T, Ha T, Liu H, Cai Y, Liu X, Li J. Chinese culture, homosexuality stigma, social support and condom use: a path analytic model. Stigma Res Action 2011; 1 27–35.
| Chinese culture, homosexuality stigma, social support and condom use: a path analytic model.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xpt1Ggt78%3D&md5=ba98c8712e536143f767e121462b5aa0CAS |
[25] Biello KB, Oldenburg CE, Mitty JA, Closson EF, Mayer KH, Safren SA, Mimiaga MJ. The “Safe Sex” conundrum: anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex. AIDS Behav 2017; 21 300–6.
| The “Safe Sex” conundrum: anticipated stigma from sexual partners as a barrier to PrEP use among substance using MSM engaging in transactional sex.Crossref | GoogleScholarGoogle Scholar |
[26] Syvertsen JL, Robertson Bazzi AM, Scheibe A, Adebajo S, Strathdee SA, Wechsberg WM. The promise and peril of pre-exposure prophylaxis (PrEP): using social science to inform prep interventions among female sex workers. Afr J Reprod Health 2014; 18 74–83.
[27] Mngadi K, Maarschalk S, Grobler A. Disclosure of microbicide gel use to sexual partners: influence on adherence in the CAPRISA 004 trial. AIDS behave 2014; 18 849–54.
| Disclosure of microbicide gel use to sexual partners: influence on adherence in the CAPRISA 004 trial.Crossref | GoogleScholarGoogle Scholar |
