PrEP use very low in Asian men who have sex with men

Use of pre-exposure prophylaxis (PrEP) is extremely low among gay, bisexual, and other men who have sex with men (GBM) in five Asian countries, reveals a study presented at the 11th International AIDS Society Conference (IAS 2021).

“Challenges in improving awareness of PrEP remain, especially in Indonesia,” said the researchers, adding that the COVID-19 pandemic had disrupted access for some.

An online cross-sectional survey targeting GBM was conducted in Indonesia, Malaysia, Vietnam, Thailand, and Japan from May 2020 to January 2021. Multivariate logistic regression was used to determine factors independently associated with current PrEP.

A total of 10,953 HIV-negative/untested GBM who reported one or more male sexual partners in the previous year (Japan: n=5,856; Vietnam: n=2,413; Thailand: n=1,172; Indonesia: n=930; Malaysia: n=582) were included in the study. [IAS 2021, abstract PEC306]

Majority of GBM had heard of PrEP (Thailand: 83.9 percent; Vietnam: 74.9 percent; Malaysia: 74.2 percent; Japan: 63.3 percent; Indonesia: 23.1 percent), but only 9.1 percent had ever used and 7.0 percent were currently using PrEP. Some 4,368 men reported any condomless anal intercourse with casual partners in the previous year, but only 10.9 percent were currently using PrEP. Substantial variation was noted by country.

Twenty-five percent of 989 PrEP-experienced respondents reported that COVID-19 had made it more difficult to access PrEP (Indonesia: 64.0 percent; Malaysia: 37.7 percent; Thailand: 36.4 percent; Japan: 21.1 percent; Vietnam: 16.8 percent).

Current PrEP users were more likely to have higher income (adjusted odds ratio [AOR], 2.29, 95 percent confidence interval [CI], 1.57–3.35; p<0.001), <20 male partners (AOR, 2.36, 95 percent CI, 1.74–3.21; p<0.001), group sex (AOR, 1.84, 95 percent CI, 1.51–2.23; p<0.001), testing for HIV (AOR, 5.4, 95 percent CI, 4.07–7.17; p<0.001) and sexually transmitted infection (STI; AOR, 2.86, 95 percent CI, 2.23–3.68; p<0.001) in the previous year, and experienced stigma in healthcare settings (AOR, 1.43, 95 percent CI, 1.02–1.99; p=0.032) when compared with nonusers.

In addition, PrEP users were less likely to identify as bisexual vs gay (AOR, 0.77, 95 percent CI, 0.59–0.99; p=0.039). Of note, current PrEP use was not associated with STI diagnosis in the previous year, education, and age.

“It is critical that PrEP be scaled up consistently across Asia and steps taken to address sexuality-related stigma in healthcare settings,” the researchers said.

These findings are consistent with those of a China study. The authors found that condomless anal intercourse and poor PrEP adherence significantly increased (from 23.6 percent to 50.1 percent) during the pandemic, while HIV testing among PrEP users decreased from 50.1 percent to 25.9 percent. PrEP use also fell from 97.9 percent to 64.3 percent. [IAS 2021, abstract PEC288]

“Our research highlights that it’s necessary to provide HIV self-testing reagents or online interventions to improve protective sexual behaviours and PrEP adherence, especially for those men who have sex with men who marry or cohabitate with females,” authors of the China study said.