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

Warittha Tieosapjaroen; Limin Mao; Horas Wong; Sujith Kumar Prankumar; Eric P F Chow; Christopher K Fairley; Tiffany R Phillips; Lei Zhang; Jason J Ong

doi:10.1016/j.lanwpc.2024.101071

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 Apr 18:46:101071. doi: 10.1016/j.lanwpc.2024.101071. eCollection 2024 May.

Authors

Warittha Tieosapjaroen^{1

2}, Limin Mao³, Horas Wong^{3

4}, Sujith Kumar Prankumar⁵, Eric P F Chow^{1

2

6}, Christopher K Fairley^{1

2}, Tiffany R Phillips^{1

2}, Lei Zhang^{1

2}, Jason J Ong^{1

2

7}

Affiliations

¹ Central Clinical School, Monash University, Carlton, Australia.
² Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
³ Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
⁴ Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia.
⁵ Kirby Institute, University of New South Wales, Sydney, Australia.
⁶ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
⁷ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Abstract

Background: Asian-born MSM are a priority population as Australia aims to end HIV transmission, but they reported additional barriers to access PrEP and other HIV prevention methods. This study investigates factors associated with PrEP use among Asian MSM in Sydney and Melbourne, Australia, to inform strategies to improve PrEP uptake in this population.

Methods: This was a sub-analysis of a community-based cross-sectional survey conducted from March to June 2021. We recruited participants online in Sydney and Melbourne, Australia. Univariable and multivariable logistic regression analyses were performed to identify the factors associated with PrEP use in the last six months and lifetime. Latent class analyses were used to identify subgroups of Asian MSM sharing similar characteristics related to their risk practices for HIV.

Findings: Overall, 870 Asian MSM were included: 288 Oceanian-born Asian MSM and 582 Asian-born MSM. Three latent classes were identified: 1) Asian-born MSM who recently arrived in Australia with limited English, were less likely to use PrEP and at higher risk of HIV infection (e.g., had condomless anal sex with a casual sex partner in the last six months) (4.6%); 2) Asian MSM who were at lower risk of HIV infection and less likely to use PrEP (69.3%) and; 3) Asian MSM who were at substantial risk of HIV infection and more likely to use PrEP (26.1%). Compared to Oceanian-born Asian MSM, those who were born in Southeast Asia (adjusted odds ratio (aOR) = 0.5, 95% confidence interval (CI) 0.3-0.7) and South Asia (aOR = 0.4, 95% CI 0.2-0.8) were less likely to ever use PrEP. Compared to Oceanian-born Asian MSM, those who were born in Southeast Asia (aOR = 0.4, 95% CI 0.3-0.7), Northeast Asia (aOR = 0.5, 95% CI 0.3-0.8) and South Asia (aOR = 0.4, 95% CI 0.2-0.7) were less likely to use PrEP in the last six months.

Interpretation: To end HIV transmission in Australia, it will be necessary to develop strategies to improve PrEP access for the significant minority of Asian-born MSM who are at substantial risk of HIV infection.

Funding: EPFC and JJO are supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (EPFC: GNT1172873 and JJO: GNT1193955). CKF is supported by an Australian National Health and Medical Research Council (NHMRC) Leadership Investigator Grant (GNT1172900).

Keywords: Asian-born; HIV/AIDS; Health policy; International migrant; Men who have sex with men; Migrant; Pre-exposure prophylaxis; Public health.