# Utilisation of HIV pre-exposure prophylaxis and preferences of alternative long-acting modalities among men who have sex with men in Hong kong: a cross-sectional study

## TL;DR

This study explores the use of HIV prevention pills and interest in long-acting alternatives among men who have sex with men in Hong Kong.

## Contribution

The study identifies factors influencing PrEP use and acceptance of long-acting injectables in a region without subsidized HIV prevention programs.

## Key findings

- Only 16% of participants were currently using PrEP, with higher use linked to higher income and risky sexual behaviors.
- Long-acting injectables were accepted by 27% of participants, with current PrEP users more likely to prefer them.
- Lack of public funding for PrEP may hinder its promotion despite increased awareness.

## Abstract

Pre-exposure prophylaxis (PrEP) has changed the paradigm of HIV prevention. A majority of men who have sex with men (MSM) were using oral tablets; meanwhile alternative long-acting modalities have been and are being developed. We aimed to assess the prevalence of PrEP use and the preferences of potential long-acting PrEP in the MSM community in Hong Kong, an Asian Pacific city where free or subsidised PrEP is not available.

A cross-sectional study was conducted using an online self-administered questionnaire. Eligible participants were adult MSM without HIV infection who normally resided in Hong Kong. Historical and current PrEP use, and preferences of using long-acting injectable for PrEP were tested against sociodemographic and sexual behavioural factors using chi-squared test and multivariable logistic regression model.

Of the 437 responses collected, 17% had ever used PrEP and 16% were currently using PrEP. Current PrEP users were more likely to have a higher income level (adjusted odds ratio [aOR] 2.11, p = 0.04), have engaged in chemsex (aOR 4.02, p < 0.01), have a non-regular male sex partner (aOR 2.66, p = 0.02), have a male sex partner living with HIV (aOR 3.60, p < 0.01), and be inclined to have condomless sex in the future (aOR 6.86, p < 0.01). Among ever users, MSM who discontinued PrEP had a lower sexual risk than current users, such as recent history of chemsex (OR 0.22, p < 0.01) and inclination to have condomless sex (OR 0.15, p < 0.01). Long-acting injectables were accepted by 27% MSM, who were more likely to be current PrEP users (odds ratio [OR] 2.35, p < 0.01), concerned about efficacy (OR 1.66, p = 0.03), and expecting to use PrEP for more than 2 years in the future (OR 9.69, p < 0.01).

The higher prevalence of PrEP among MSM indicated an increased awareness over the past decade. However, its promotion could have been hindered by the absence of a publicly funded or subsidised programme. While PrEP users had a higher sexual risk, the utilisation pattern would be affected by the dynamicity of sexual activities. Long-acting injectables had a moderate acceptance rate. Current PrEP users and those anticipated long-term users could be prioritised for its promotion.

The online version contains supplementary material available at 10.1186/s12889-025-26025-5.