Low pre-exposure prophylaxis (PrEP) uptake and high prevalence of sexually transmitted infections among men who have sex with men in Zhejiang Province, China: a large cross-sectional survey.

BACKGROUND

Pre-exposure prophylaxis (PrEP) demonstrates substantial efficacy in preventing human immunodeficiency virus (HIV) among men who have sex with men (MSM). However, its promotion faces barriers, with implementation raising concerns about declining condom use and a potential increase in the incidence of sexually transmitted infections (STIs). This study investigated the factors associated with PrEP uptake and STIs status among MSM to inform strategies for PrEP implementation in this group.

METHODS

From July to December 2023, a cross-sectional study was conducted among MSM in Zhejiang Province, China. Data on demographic characteristics, PrEP knowledge and uptake, sexual behaviors, and HIV testing were collected using online questionnaires. Chi-square tests were used to compare the differences between the PrEP uptake and non-uptake groups, and logistic regression was applied to analyze the associated factors with PrEP uptake.

RESULTS

A total of 5816 MSM who met the inclusion criteria were recruited, of whom 321 (5.5%, 95% CI: 4.92%-6.08%) reported PrEP uptake. Multivariate logistic regression identified key factors associated with PrEP uptake. Positively associated factors included higher education (junior college: adjusted odds ratio [aOR]: 1.54, 95% CI: 1.02-2.33, P = 0.042; bachelor's degree: aOR: 1.81, 95% CI: 1.22-2.69, P = 0.004; master's and above: aOR: 2.50, 95% CI: 1.55-4.04, P < 0.001), having two or more sexual partners (aOR: 1.91, 95% CI: 1.17-3.10, P = 0.009), occasional condom use (aOR: 1.83, 95% CI: 1.42-2.35, P < 0.001), frequent (aOR: 2.11, 95% CI: 1.59-2.80, P < 0.001) or occasional (aOR: 1.39, 95% CI: 1.02-1.88, P = 0.035) rush popper use, and STI history (aOR: 2.82, 95% CI: 1.71-4.64, P < 0.001). Conversely, freelance occupation was inversely associated with uptake (aOR: 0.65, 95% CI: 0.43-0.99, P = 0.046).

CONCLUSIONS

The prevalence of PrEP uptake among MSM in Zhejiang Province remains relatively low. Factors including lower educational level, freelance employment, multiple sexual partnerships, occasional condom use, and rush popper use were correlated with uptake. Importantly, individuals with a history of STIs were more likely to use PrEP, underscoring the need to integrate STI screening into routine PrEP services. These findings provide a critical evidence base for promoting PrEP and for developing tailored HIV/STI prevention strategies targeting MSM.