# Pre-exposure prophylaxis against HIV infection among male population under perceived risk of sexually transmitted infections in Vojvodina, Serbia: a cross-sectional study on knowledge and attitudes

## TL;DR

This study in Serbia found that while many men at risk of HIV know about PrEP, only a small percentage use it, and accurate knowledge is key to positive attitudes toward it.

## Contribution

The study provides novel insights into PrEP knowledge, attitudes, and usage among at-risk men in Vojvodina, Serbia.

## Key findings

- 71% of participants were aware of PrEP, but only 17.2% had used it.
- Correct PrEP knowledge was the strongest predictor of a positive attitude toward PrEP.
- Age, online app use for meeting partners, and prior PrEP use were associated with better PrEP knowledge.

## Abstract

Globally, awareness and use of pre-exposure prophylaxis (PrEP) for preventing HIV vary widely. This cross-sectional study assessed knowledge, attitudes, and experiences related to PrEP use among sexually active men in Vojvodina, Serbia.

Study was conducted from July to December 2024. Data were collected by seven district public health institutes in Vojvodina and two NGO community checkpoints. Participants were adult men with perceived high-risk sexual behaviour, infection symptoms, or seeking sexual health advice, regardless of their sexual orientation. Participation was anonymous and involved a structured self-administered questionnaire.

Among 597 participants (28.3% of clients counselled and/or tested across nine centres), 71.0% were aware of PrEP and 17.2% had previously used it. About 55% of participants had correct basic PrEP knowledge, 28.8% incomplete, and 18.8% insufficient. Overall, 80.2% expressed a positive attitude toward PrEP, 11.7% were undecided, and 8.1% have negative attitude. Age categories (31–40 years: OR = 1.66, 95% CI: 1.01–2.73, p = 0.047), consistent use of online apps to meet partners (OR = 1.98, 95% CI: 1.09–3.62, p = 0.026), and prior PrEP use (OR = 2.12, 95% CI:1.33–3.40, p = 0.002) were associated with higher odds of correct PrEP knowledge. Correct knowledge was the strongest predictor of a positive attitude toward PrEP (OR = 3.21, 95% CI: 1.68–6.12, p < 0.001).

Despite high awareness, use of PrEP was limited, and accurate knowledge strongly predicted positive attitudes, underscoring the importance of education and counselling. Enhancing public health capacity, reducing stigma, and improving information flow are essential for effective, equitable HIV prevention in Serbia and the wider Central and Eastern Europe region.