Understanding Awareness, Utilization, and the Awareness-Utilization Gap of HIV PrEP and nPEP Among Young MSM in China

HIV/AIDS remains a significant public health challenge in China, particularly among men who have sex with men (MSM). Pre-Exposure Prophylaxis (PrEP) and non-occupational post-exposure Prophylaxis (nPEP) are effective interventions to reduce HIV transmission in high-risk populations. This study assessed awareness and utilization levels of PrEP and nPEP among young MSM (YMSM) aged 18-29 in China and examined associated factors. A cross-sectional survey of 2,493 YMSM was conducted across six Chinese provinces in September 2022. Participants, recruited via facility-based sampling, completed self-administered online questionnaires distributed by MSM-oriented community-based organizations. Of all the participants, 2,278 (91.4%) were aware of PrEP, and 220 (8.8%) had ever used PrEP; 2,321 (93.1%) were aware of nPEP, and 209 (8.4%) had ever used nPEP. Education level and having recent male sexual partners were positively associated with awareness of PrEP and nPEP, while self-stigma was negatively associated with awareness for both. Among those who had head of PrEP or nPEP, age, having more than 2 male sex partners, and having a history of sexually transmitted diseases (STD) infection were positively associated with the utilization of PrEP and nPEP; inconsistent condom use was associated with less PrEP utilization; monthly income was positively associated with nPEP utilization. Despite high awareness levels, the low utilization of PrEP and nPEP highlights missed opportunities for HIV prevention. Strengthening education on their importance, promoting condom use alongside PrEP/nPEP, reducing stigma, and addressing financial barriers are critical steps toward improving HIV prevention strategies and empowering YMSM to engage with these life-saving interventions.