Background: Oral pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV infection risk among men who have sex with men (MSM). Despite escalating HIV prevalence among MSM in Taiwan, little is known about awareness and acceptability of PrEP, or possible barriers to using PrEP. We examined factors associated with awareness and acceptability of PrEP among MSM in Taiwan.
Methods: From July-August 2014, we conducted a cross-sectional, self-administered paper-and-pencil (30-minute) survey among a convenience sample of MSM recruited from two LGBTQ community-based organizations in Taipei and Taichung, Taiwan. Items included socio-demographic characteristics, sexual risk behaviors, vicarious HIV stigma, anticipated PrEP disclosure, and PrEP awareness and acceptability. Multivariate logistic regression was conducted with PrEP awareness and acceptability as dependent variables.
Results: Participants'' (n=176) mean age was 27.4 years; 87.5% self-identified as gay. Nearly one-third (31.3%) of participants reported inconsistent condom use; mean number of male sex partners was 2.3, past 3 months. Nearly half (47.2%) 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 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: 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 medication for prevention; however, marshalling PrEP awareness may be particularly warranted among MSM who engage in condomless sex with multiple partners. The associations of stigma and anticipated disclosure of PrEP use with acceptability may reflect the collectivistic orientation of Taiwanese culture, and suggest that social marketing efforts consider emphasizing benefits to others as well as oneself in promoting PrEP acceptability.

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