Pre-Exposure Prophylaxis (PrEP) As an HIV Prevention Strategy: Awareness and Acceptability of PrEP Among Men Who Have Sex with Men in Taiwan

Background and Purpose:
The number of newly diagnosed HIV infections among men who have sex with men (MSM) has been consistently growing in Taiwan. Recently, the Centers for Disease Control in Taiwan estimated that half of people living with HIV/AIDS are MSM. New preventive interventions to reduce HIV infections among MSM are needed. Pre-exposure prophylaxis (PrEP) refers to the daily use of HIV medication by people at high risk for HIV to lower their risk of infection. PrEP has demonstrated 86% or greater reductions in the risk of HIV acquisition among MSM in the U.S. Despite escalating HIV prevalence among MSM in Taiwan, little is known about awareness and acceptability of PrEP, or possible barriers to using PrEP among MSM. The importance of this study is to increase awareness and acceptability of PrEP to curtail the HIV epidemic among MSM in Taiwan.

Methods:

From July-August 2014, we conducted a cross-sectional, self-administered paper-and-pencil (30-minute) survey. A convenience sample of MSM was recruited from two LGBTQ community-based organizations in Taipei and Taichung, Taiwan. Items included socio-demographic characteristics, sexual risk behaviors, HIV stigma, anticipated PrEP disclosure, and PrEP awareness and acceptability. Multivariate logistic regression was conducted with PrEP awareness and acceptability as dependent variables.

Results:

We approached 221 potential participants, and 21 declined, for a response rate of 90.5%. Participants who self-identified as HIV-negative (n = 176) were included in this analysis. Participants’ mean age was 27.4 years; 87.5% self-identified as gay. Nearly one-third (31.3%) reported inconsistent condom use; mean number of male sex partners was 2.3 in the past 3 months. Less than half (47.2%) of participants were aware of PrEP. The majority (72.2%) would accept PrEP if it became available in the future. In multivariate logistic regression, higher income (>30,000 TWD; $893 USD) (AOR=0.36, 95% CI=0.16–0.80) and inconsistent condom use (AOR=0.34, 95% CI=0.14–0.81) were associated with lower odds of PrEP awareness, and having heard about MSM who are HIV negative taking HIV medications before condomless sex (prior to PrEP licensure) (AOR=25.27, 95% CI=7.43–85.95) was associated with higher odds of PrEP awareness. Higher vicarious HIV stigma (AOR=2.47, 95% CI=1.34–4.56) and willingness to tell sex partners about using PrEP (AOR=6.08, 95% CI=2.30–16.06) were associated with higher odds of PrEP acceptability.

Conclusions and Implications:

Our findings suggest the need for tailored educational and social marketing efforts to prepare for the introduction of PrEP for MSM in Taiwan. Some MSM were aware of off-label use of HIV medications for prevention; however, marshalling PrEP awareness may be particularly warranted among MSM who engage in condomless sex with multiple partners, who are at high risk for HIV acquisition. The associations of stigma and anticipated disclosure of PrEP use with acceptability may reflect the collectivistic orientation of Taiwanese culture, and suggest that culturally appropriate social marketing efforts consider emphasizing benefits to others as well as oneself in promoting PrEP acceptability. With vastly disproportionate HIV prevalence among MSM globally, social and behavioral research among MSM in diverse cultural settings may support the effectiveness of PrEP.