Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China

Pre-exposure prophylaxis (PrEP) is recommended as an HIV prevention strategy for key populations, in particular men who have sex with men (MSM). However, the willingness to pay market rate for PrEP is largely unknown. This study aimed to investigate the willingness to pay for PrEP and its associated factors among MSM living in Mainland China. A cross-sectional survey was conducted among 689 MSM who were recruited through a gay-friendly health consulting service center in Chengdu, China during 2018-2019. We collected information on participants' willingness to pay for PrEP and its potential correlates (e.g., PrEP awareness and acceptability, perceived risk of HIV infection) using a structured questionnaire. Univariate and multivariate logistic regression were used for data analyses. Only 14.1% of respondents indicated they would not pay any money for PrEP, around half (49.3%) would like to pay $14-84 per month, and very few (6.8%) would like to pay ≥283 per month (market rate). We found that PrEP awareness (unadjusted odds ratio (ORu) = 1.41; 95% CI: 1.01-1.97), acceptability (ORu =1.20; 95% CI: 1.07-1.34), perceived PrEP adherence (ORu =1.23; 95% CI: 1.08-1.41), and perceived PrEP benefit in reducing condom use (ORu =1.29; 95% CI: 1.07-1.55) were all associated with participants' willingness to pay the market rate for PrEP. Other facilitators of PrEP pay willingness included full disclosure of sexual orientation to health professionals, high HIV literacy, and a high degree of HIV disclosure with sex partners. The overall willingness to pay for the market rate of PrEP was low among this urban sample of Chinese MSM. Programs aiming to promote PrEP pay willingness should provide enhanced counseling to improve PrEP-related cognition, deliver accurate HIV/PrEP information to increase health literacy, and decrease stigma towards sexual minorities to develop trust with health professionals.