Study On The Willingness Of HIV Post-exposure Prophylaxis And Its Associated Factors Among Nonmarital Heterosexual Males And Female Sex Workers

BackgroundAs a chronic infectious disease with high mortality,AIDS has become one of the major public health problems in the world.Heterosexual transmission is the main route of HIV transmission in China,including nonmarital heterosexual sexual transmission and sero-discordant couple sexual transmission,in which nonmarital heterosexual sexual transmission is the main way.Nonmarital heterosexual sexual transmission includes commercial sexual transmission and nonmarital non-commercial heterosexual contact(NMCHC)transmission.Commercial sexual transmission,that is,the commercial sexual behavior of female sex workers(FSW)and their clients(CFSW),has become the main way of heterosexual sexual transmission.At the same time,NMCHC transmission is transmitting HIV to the general population through high-risk groups.We still need to pay attention to FSW,CFSW and NMCHC due to the hidden and unstable nature of these three groups,although the HIV prevalence has been at a low level and there are relatively few studies on NMCHC population in China.Although traditional prevention and control measures have achieved certain results in controlling the spread of HIV,but emerging intervention measures are urgently needed with the changing epidemic of HIV.Non-occupational post-exposure prophylaxis(nPEP)refers to taking antiretroviral drugs within 72 hours for 28 days after unprotected sexual behavior,sharing needles and other non occupational exposure ways to prevent HIV infection.Many studies have confirmed the effectiveness of nPEP.At present,many countries have promulgated nPEP guidelines suitable for their own countries,but not China.Before popularizing nPEP,it is necessary to know about the demand of nonmarital heterosexual males and FSW for nPEP services,to provide scientific basis for the future development of nPEP services in China.ObjectivesThe purposes of this study are to investigate the awareness and willingness,related needs of nPEP services of nonmarital heterosexual males and FSW in China,to explore the factors influencing awareness and willingness of nPEP,and to provide scientific basis for the development of nPEP in China.MethodsCross-sectional surveys among nonmarital heterosexual males in Jinan and Haikou,FSW in Zhengzhou,Nanchang and Biyang were conducted using electronic and paper questionnaires.After collating all the collected questionnaires and removing invalid questionnaires,SPSS 24.0 was used to analyze the demographic characteristics,behavioral information,nPEP awareness and willingness,etc.,and χ2 test was performed on the different characteristics of the two survey populations.Using awareness and willingness of nPEP as the dependent variables,logistic regression model was used to explore potential related factors.Factors with P<0.1 in univariate analysis were included in multivariate logistic regression to calculate OR(95%CI).The difference was considered statistically significant when P<0.05.Results1.Demographic characteristicsA total of 383 questionnaires were included in the analysis of nonmarital heterosexual males,89.0%are under the age of 40,76.7%had lived locally for more than 2 years,85.4%had a high school education or above,and 42.0%had a monthly income of more than 5,000 RMB.Of the 400 FSWs,55.0%are over the age of 40,66.8%had lived in the local area within 2 years,76.8%had a junior high school education or below,and 69.3%had a monthly income of less than 3,000 RMB.2.AIDS knowledge and behavioral characteristicsThe awareness rates of AIDS knowledge among FSW and nonmarital heterosexual males were both 83.8%.The acceptance rate of FSW was higher than that of nonmarital heterosexual males.60.3%of nonmarital heterosexual males had both commercial and non-commercial temporary sexual partners in the past year,53.3%could insist on using condoms,62.7%had high-risk sexual behaviors.Over three-quarter(76.8%)of FSW can insist on using condoms when they had commercial sex in the last month,63.8%had high-risk sexual behaviors.There was not significantly difference in the high-risk sexual behaviors between FSW and nonmarital heterosexual males.3.Awareness and willingness of nPEP and associated factorsMore than half(52.0%)of nonmarital heterosexual males had heard of nPEP,13.1%of them had ever used nPEP,and 80.2%have willingness to use nPEP.Fifteen percent of FSW had heard of nPEP,no one had used it,and 42.8%had willingness to use nPEP.Awareness,willingness and knowledge of nPEP of nonmarital heterosexual males was higher than that of FSW.They all knew the nPEP applicable exposure behavior,while the other knowledge is lower.The results of multivariate logistic regression showed that among the nonmarital heterosexual males,registering in other cities of the province(AOR:0.504,95%CI:0.306-0.830),the number of commercial sexual partners in the past year was more than 3(AOR:0.465,95%CI:0.274-0.787)were associated with lower awareness of nPEP.Having a high school education or above(AOR:2.744,95%CI:1.292-5.825),having received HIV related services(AOR:2.961,95%CI:1.801-4.867),having tested for more than once in the last year(AOR:2.343,95%CI:1.270-4.322;AOR:2.159,95%CI:1.044-4.465),knowing AIDS knowledge(AOR:2.083,95%CI:1.081-4.014)were associated with higher awareness of nPEP.Knowing nPEP(A OR:1.894,95%CI:1.127-3.192)was associated with higher willingness of nPEP.The results of multivariate logistic regression showed that among the nonmarital heterosexual males,Marital status was love/cohabitation/married,divorced/widowed/separated(AOR:0.301,95%CI:0.153-0.593;AOR:0.360,95%CI:0.134-0.966),drinking frequency in the past 3 months was 1-3 times/month,≥1 time/week(AOR:0.264,95%CI:0.089-0.784;AOR:0.166 95%CI:0.049-0.560),having high-risk behaviors(AOR:0.449,95%CI:0.244-0.824)were associated with lower awareness of nPEP.Having a monthly income of more than 5,000 RMB(AOR:3.661,95%CI:1.502-8.922),knowing AIDS knowledge(AOR:3.030,95%CI:1.056-8.698)were associated with higher awareness of nPEP.Older than 40(AOR:0318,95%CI:0.162-0.624).Having a monthly income of more than 5,000 RMB(AOR:0.413,95%CI:0.185-0.922),having received HIV related services(AOR:0.161,95%CI:0.072-0.357),having high-risk behaviors(AOR:0.426,95%CI:0.263-0.689)were associated with lower willingness of nPEP.Having lived in the local area for more than 2 years(AOR:3.904,95%CI:2.348-6.492),having a monthly income of 3001-5000 RMB(AOR:3.780,95%CI:1.783-8.013),knowing nPEP(A OR:1.965,95%CI:1.019-3.790)were associated with higher willingness of nPEP.4.Needs for nPEPAbout three-quarter(73.1%)of nonmarital heterosexual males thought that the acceptable price of nPEP drug was within 3,000 RMB,and 82.3%of FSW was within 1,000 RMB.Both groups hoped to get medicines in hospital or CDC,and learn about nPEP information through doctors,CDC,network/social media/mobile phone software.They had needs for all aspects of nPEP knowledge.5.Impacts of nPEP popularizing on sexual behaviorsLess than half(43.5%)of nonmarital heterosexual males considered that the condom using of himself would increase,31.6%considered that the condom using of nonmarital heterosexual males group would decrease,30.3%considered that the number of sexual partners of himself would increase,47.9%considered that the number of sexual partners of group would increase.FSWs who believed that there would no change in condom use of individual and the population were 81.3%and 80.0%,respectively,and 82.0%and 78.3%believed that there would no change in the number of sexual partners of individual and the population.Conclusions1.There is a serious separation between knowledge and behavior among nonmarital heterosexual males and FSW,and there are some misunderstandings and shortcomings in AIDS knowledge,especially in FSW population.At present,knowledge and behaviors propaganda and intervention are still needed to improve the comprehensive understanding of AIDS knowledge and reduce the high-risk sexual behaviors.2.The awareness and willingness of nPEP services are lower in the FSW group,so there may be difficult to popularize nPEP services in this group,while the nonmarital heterosexual males have a relatively higher awareness and willingness of nPEP services,which provide a certain basis to popularize nPEP services in the future.Doctors and CDC are effective ways to propaganda nPEP,and the advantages of the network should be made full use of to promote the publicity effect,which can protect the privacy of the audiences and increase its publicity effect.3.The awareness of nPEP services is a common factor affecting the willingness of the two groups,which suggesting that the publicity of nPEP to improve the awareness of npep knowledge of high-risk exposed people is the key to popularize this service in the future.When popularizing nPEP service,we should focus on FSW who are older,have received HIV related services,high-risk sexual behaviors,lower awareness of AIDS knowledge,especially economic factors;actively carry out HIV testing and other related services to increase the access of nonmarital heterosexual males to nPEP services,improve awareness and willingness of nPEP and establish psychological counseling services to improve the cognition of nPEP service and reduce the psychological pressure caused by medications.4.Attention need to be paid to the problem of "behavior disinhibition" when popularizing nPEP and remind the demanders that nPEP services can only be used as a supplementary medical measure.Persisting in the use of condoms and reducing the number of sexual partners are still the main effective ways to reduce the risk of HIV infection.