# Awareness, Acceptance, and Uptake of HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men (MSM) in Northwestern China: A Cross-Sectional Study

## TL;DR

This study examines how aware and willing men who have sex with men in northwestern China are to use HIV prevention drugs, finding that high costs and education gaps are major barriers.

## Contribution

The study identifies factors influencing PrEP uptake and highlights disparities in awareness and acceptance among MSM in China.

## Key findings

- Only 8.8% of PrEP-eligible participants had used PrEP, with cost being a major barrier.
- Rural residence and lower education levels correlated with reduced PrEP awareness and acceptance.
- Higher income and recent STI testing predicted greater PrEP acceptance.

## Abstract

We assessed the awareness, acceptance (willingness to use), and uptake of pre-exposure prophylaxis (PrEP), along with the gap between PrEP eligibility and self-perceived HIV risk among men who have sex with men (MSM) in Shaanxi Province, China in 2022. Participants completed surveys on PrEP, and were screened for HIV, syphilis, Chlamydia trachomatis, and Neisseria gonorrhoeae. PrEP eligibility was determined using Chinese PrEP guidelines, and participants’ self-perceived HIV risk was documented. Multivariable logistic regression Analysed factors influencing PrEP-related outcomes And the discrepancy between perceived and actual risk. Among 1,085 participants (median age: 32 years), 54.4% resided in urban areas, 71.1% identified as homosexual, And 60.8% held a college degree or higher. Although 87.0% were PrEP-eligible, only 28.5% were identified as high risk. PrEP awareness was 82.0%, yet only 8.8% had used it, And 3.3% currently used it. Despite 72.9% expressing willingness, uptake was hindered by high costs. Rural residence and lower education correlated with reduced awareness and acceptance, while greater income, more male partners, and recent STI testing predicted higher acceptance. Prior PEP use was strongly associated with PrEP use. Targeted efforts to improve affordability, accessibility, and education are crucial for better prevention results.

The online version contains supplementary material available at 10.1007/s10461-025-04884-8.