Preferences and willingness to use pre-exposure prophylaxis for HIV among men who have sex with men in mainland China and Hong Kong

Jiajun Sun; Jason J. Ong; Heather-Marie Schmidt; Curtis Chan; Benjamin R. Bavinton; Kimberly Elizabeth Green; Nittaya Phanuphak; Midnight Poonkasetwattana; Nicky Suwandi; Doug Fraser; Weiming Tang; Michael Cassell; Hua Boonyapisomparn; Edmond Pui Hang Choi; Lei Zhang; Warittha Tieosapjaroen

doi:10.1071/SH24247

RESEARCH ARTICLE (Open Access)

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Preferences and willingness to use pre-exposure prophylaxis for HIV among men who have sex with men in mainland China and Hong Kong

Jiajun Sun

https://orcid.org/0000-0001-5529-6660

^A ^B , Jason J. Ong

https://orcid.org/0000-0001-5784-7403

^A ^B ^C , Heather-Marie Schmidt

https://orcid.org/0000-0002-2629-6407

^D ^E , Curtis Chan

https://orcid.org/0000-0002-9581-1011

^F , Benjamin R. Bavinton

https://orcid.org/0000-0001-5834-8278

^F , Kimberly Elizabeth Green

https://orcid.org/0000-0002-0848-8480

^G , Nittaya Phanuphak

https://orcid.org/0000-0002-0036-3165

^H ^I , Midnight Poonkasetwattana ^J , Nicky Suwandi ^K , Doug Fraser ^F , Weiming Tang

https://orcid.org/0000-0002-9026-707X

^L , Michael Cassell ^M , Hua Boonyapisomparn ^K , Edmond Pui Hang Choi

https://orcid.org/0000-0001-9062-3540

^N , Lei Zhang

https://orcid.org/0000-0003-2343-084X

^A ^B ^O ^P ^# ^* and Warittha Tieosapjaroen ^A ^B ^# ^*

+ Author Affiliations

- Author Affiliations

^A School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.

^B Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia.

^C Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.

^D Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.

^E World Health Organization, Geneva, Switzerland.

^F Kirby Institute, University of New South Wales, Sydney, NSW, Australia.

^G PATH, Hanoi, Vietnam.

^H Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.

^I Centre of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand.

^J Asia Pacific Coalition on Male Sexual Health (APCOM), Bangkok, Switzerland.

^K Asia Pacific Transgender Network, Bangkok, Thailand.

^L The University of North Carolina at Chapel Hill Project-China, Guangzhou, China.

^M Family Health International (FHI) 360, Durham, NC, USA.

^N School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

^O China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China.

^P Phase I Clinical trial research ward, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China.

^* Correspondence to: [email protected], [email protected]

^# Co-senior author

Handling Editor: Ian Simms

Sexual Health 22, SH24247 https://doi.org/10.1071/SH24247

Submitted: 20 December 2024 Accepted: 7 May 2025 Published: 26 May 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Pre-exposure prophylaxis (PrEP) uptake remains low in mainland China and Hong Kong. We examined preferences for different PrEP modalities among men who have sex with men (MSM) in mainland China and Hong Kong.

Methods

We conducted a cross-sectional online survey from May to November 2022 in mainland China and Hong Kong. Eligible participants were aged ≥18 years, identified as MSM and self-reported HIV-negative, or unknown HIV status. Random forest models and SHapley Additive exPlanations analyses were used to identify key factors influencing preferences for and willingness to use six PrEP options: (1) daily oral, (2) on-demand oral, (3) monthly oral, (4) two-monthly injectable, (5) six-monthly injectable, and (6) implantable PrEP.

Results

Among 2142 participants (mainland China: 1604; Hong Kong: 538), the mean age was 28.4 (±7.0) years in mainland China and 34.7 (±9.5) years in Hong Kong. Current PrEP use was similar between mainland China and Hong Kong (18.0% vs 17.8%, P = 0.93), with an additional 10.5% and 8.0% reporting past PrEP use (P = 0.11), respectively. A greater proportion of participants from mainland China preferred on-demand PrEP compared to those from Hong Kong (55.7% vs 48.1%, P < 0.01), whereas more participants from Hong Kong preferred monthly oral PrEP (53.2% vs 47.3%, P = 0.02). Willingness to use non-oral options was lower, with two-monthly injectable PrEP preferred by 21.1% (19.1–23.1%) in mainland China and 15.4% (12.3–18.5%) in Hong Kong (P < 0.01). Among Hong Kong participants, condom use frequency and migration status were important predictors of willingness to use both oral and injectable PrEP options. Current PrEP use status and PrEP attitudes were consistently important predictors. Additionally, individuals who preferred six-monthly injectable PrEP tended to dislike the two-monthly option.

Conclusions

On-demand and monthly PrEP options remain the preferred choices, though the monthly oral option is neither proven nor available. However, the factors influencing these preferences vary, highlighting the need for tailored and targeted approaches to PrEP implementation.

Keywords: China, HIV prevention, Hong Kong, machine learning, men who have sex with men, pre-exposure prophylaxis, Preference research, random forest.

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