Lower PrEP Use Found in MSM Immigrants of Asian Descent

Pre-exposure prophylaxis (PrEP) had lower uptake among Asian men who have sex with men (MSM) who had recently immigrated to Australia, according to a new study published in The Lancet Regional Health – Western Pacific.¹ Immigrating from certain areas of Asia was associated with the odds of PrEP uptake.

HIV cases have increased in Asian MSM within Australia by 54% at a time when overall HIV cases in MSM have decreased by 45% and viral suppression has reached approximately 74%.² Asian men are less likely to report risk behaviors for HIV compared with other groups. PrEP can be used to prevent HIV in MSM and is available through Australia’s universal health insurance. This study aimed to evaluate the factors that were associated with the use of PrEP in MSM of Asian descent.

Pre-exposure prophylaxis | Image credit: Orawan - stock.adobe.com

This study used the Gay Asian Men’s Community Survey for data. The survey was conducted between March and June 2021 in Sydney and Melbourne. All participants were recruited online or through community organizations. The survey was given in English, Chinese, and Thai. MSM of Asian descent could be born in either Asia, Australia, or any other country. MSM of Asian descent were defined as those who reported themselves to be gay, bisexual, nonbinary, or queer who had sex with men and identified as Southeast, Northeast, or South Asian. Participants were MSM who were 18 years and older and did not have a diagnosis of HIV prior to the survey.

Patients were excluded if they were only attracted to women, were living with HIV, were assigned female at birth, or were bisexual women. MSM were described as “recently arrived” if they had immigrated within the previous 5 years.

There were 870 MSM who were included in this study, of whom 34.0% were born in Oceania and 66.0% were born in Asia. The participants had a median (IQR) age of 30 (26-36) years. A total of 8.6% had limited proficiency with English, 44.4% had more than 1 sexual partner, and 21.1% were designated as having recently arrived in Australia. A total of 12.4% had a sexually transmitted infection (STI) within the previous year.

Of MSM who were born in Oceania, 53.4% had used PrEP at any point, whereas 43.2% of those born in Asia had used PrEP. A total of 48.5% of MSM who were eligible for Medicare had ever used PrEP vs 37.5% of those who were not eligible. MSM were less likely to use PrEP if they were from Southeast Asia (adjusted OR [aOR], 0.46; 95% CI, 0.29-0.73) or South Asia and other Asian regions (aOR, 0.37; 95% CI, 0.19-0.72). MSM were twice as likely to use PrEP if they had more than 1 sexual partner (aOR, 2.32; 95% CI, 1.28-4.21) compared with those without a sexual partner; this extended to those who had an STI diagnosis within the previous year (aOR, 2.00; 95% CI, 1.11-3.61).

MSM who had condomless sex (aOR, 5.97; 95% CI, 3.30-11.12) and those without a partner (aOR, 3.83; 95% CI, 2.08-7.05) were more likely to take PrEP compared with MSM who always used condoms. On-demand PrEP was slightly more popular in Asian MSM compared with daily PrEP (55.5% vs 44.5%).

Within the previous 6 months MSM born in Southeast Asia (aOR, 0.43; 95% CI, 0.26-0.70), Northeast Asia (aOR, 0.50; 95% CI, 0.30-0.83), and South Asia and other Asian regions (aOR, 0.37; 95% CI, 0.19-0.73) were less likely to use PrEP compared with Asian MSM born in Oceania. MSM who had condomless sex (aOR, 6.00; 95% CI, 3.20-11.24) and those without a partner (aOR, 3.80; 95% CI, 1.97-7.33) were more likely to use PrEP compared with those who used condoms.

There were some limitations to this study. Participants born overseas had lower participation due to conducting the survey online during the COVID-19 pandemic and the closure of international borders. The COVID-19 pandemic also led to changes in sexual activity and the use of PrEP. The generalizability to Asian MSM populations is limited due to the sampling methods used for recruitment. Sparse-data bias is likely the cause of the large OR CI, and unmeasured confounding factors existed.

The researchers concluded that PrEP utilization was lower in Asian MSM, who represent a minority group vulnerable to HIV infection in Australia. Approaching patients in a more tailored way and integrating HIV services to better treat HIV in this demographic is needed to reduce the number of cases and improve PrEP utilization.

References

1. Tieosapjaroen W, Mao L, Wong H, et al. Factors associated with HIV pre-exposure prophylaxis use among Asian men who have sex with men in Sydney and Melbourne, Australia: a cross-sectional study. Lancet Reg Health West Pac. 2024;46:101071. doi:10.1016/j.lanwpc.2024.101071
2. HIV viral suppression rate in U.S. lowest among comparable high-income countries, 2020 or latest year. KFF. June 3, 2022. Accessed April 29, 2024. https://www.kff.org/hivaids/slide/hiv-viral-suppression-rate-in-u-s-lowest-among-comparable-high-income-countries-2020-or-latest-year/