PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey
Abstract Introduction Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre‐exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to exami...
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Wiley
2025-04-01
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| Series: | Journal of the International AIDS Society |
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| Online Access: | https://doi.org/10.1002/jia2.26438 |
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| author | Gede Benny Setia Wirawan Heather‐Marie Schimdt Curtis Chan Doug Fraser Jason J. Ong Michael Cassell Lei Zhang Warittha Tieosapjaroen Nittaya Phanuphak Weiming Tang Nicky Suwandi Kimberly E. Green Timothy Dobbins Benjamin R. Bavinton |
| author_facet | Gede Benny Setia Wirawan Heather‐Marie Schimdt Curtis Chan Doug Fraser Jason J. Ong Michael Cassell Lei Zhang Warittha Tieosapjaroen Nittaya Phanuphak Weiming Tang Nicky Suwandi Kimberly E. Green Timothy Dobbins Benjamin R. Bavinton |
| author_sort | Gede Benny Setia Wirawan |
| collection | DOAJ |
| description | Abstract Introduction Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre‐exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP. Methods The PrEP APPEAL survey was a cross‐sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self‐identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness. Results Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower‐middle‐income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (n = 11,427/13,899) of participants were aware of PrEP, 35.0% (n = 4000/11,427) had used it before and 70.1% (n = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (n = 4068/7427) PrEP‐naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (n = 2996/4068) of them expressed willingness to use PrEP and 83.0% (n = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system‐level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual‐level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness. Conclusions While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale‐up efforts. Future PrEP programmes should address system‐level barriers to support PrEP uptake. |
| format | Article |
| id | doaj-art-ed234c8138274a8ab7ff37be061cdf83 |
| institution | OA Journals |
| issn | 1758-2652 |
| language | English |
| publishDate | 2025-04-01 |
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| series | Journal of the International AIDS Society |
| spelling | doaj-art-ed234c8138274a8ab7ff37be061cdf832025-08-20T02:33:11ZengWileyJournal of the International AIDS Society1758-26522025-04-01284n/an/a10.1002/jia2.26438PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL surveyGede Benny Setia Wirawan0Heather‐Marie Schimdt1Curtis Chan2Doug Fraser3Jason J. Ong4Michael Cassell5Lei Zhang6Warittha Tieosapjaroen7Nittaya Phanuphak8Weiming Tang9Nicky Suwandi10Kimberly E. Green11Timothy Dobbins12Benjamin R. Bavinton13Kirby Institute, UNSW Sydney New South Wales AustraliaJoint United Nations Programme on HIV/AIDS (UNAIDS) Geneva SwitzerlandKirby Institute, UNSW Sydney New South Wales AustraliaKirby Institute, UNSW Sydney New South Wales AustraliaSchool of Translational Medicine Monash University Melbourne Victoria AustraliaFHI 360 Hanoi VietnamSchool of Translational Medicine Monash University Melbourne Victoria AustraliaSchool of Translational Medicine Monash University Melbourne Victoria AustraliaInstitute of HIV Research and Innovation (IHRI) Bangkok ThailandSocial Entrepreneurship to Spur Health Global Guangzhou ChinaAsia‐Pacific Coalition on Male Sexual Health Bangkok ThailandPATH, Primary Health Care Seattle Washington USASchool of Population Health, UNSW Sydney New South Wales AustraliaKirby Institute, UNSW Sydney New South Wales AustraliaAbstract Introduction Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre‐exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP. Methods The PrEP APPEAL survey was a cross‐sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self‐identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness. Results Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower‐middle‐income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (n = 11,427/13,899) of participants were aware of PrEP, 35.0% (n = 4000/11,427) had used it before and 70.1% (n = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (n = 4068/7427) PrEP‐naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (n = 2996/4068) of them expressed willingness to use PrEP and 83.0% (n = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system‐level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual‐level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness. Conclusions While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale‐up efforts. Future PrEP programmes should address system‐level barriers to support PrEP uptake.https://doi.org/10.1002/jia2.26438men who have sex with menpre‐exposure prophylaxiscascadeAsiaHIVHIV prevention |
| spellingShingle | Gede Benny Setia Wirawan Heather‐Marie Schimdt Curtis Chan Doug Fraser Jason J. Ong Michael Cassell Lei Zhang Warittha Tieosapjaroen Nittaya Phanuphak Weiming Tang Nicky Suwandi Kimberly E. Green Timothy Dobbins Benjamin R. Bavinton PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey Journal of the International AIDS Society men who have sex with men pre‐exposure prophylaxis cascade Asia HIV HIV prevention |
| title | PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey |
| title_full | PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey |
| title_fullStr | PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey |
| title_full_unstemmed | PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey |
| title_short | PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey |
| title_sort | prep use and willingness cascades among gbmsm in 15 asian countries territories an analysis of the prep appeal survey |
| topic | men who have sex with men pre‐exposure prophylaxis cascade Asia HIV HIV prevention |
| url | https://doi.org/10.1002/jia2.26438 |
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