{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T12:28:59Z","timestamp":1792326539238,"version":"4.4.0"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008810","name":"NSW Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008810","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre\u2010exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PrEP APPEAL survey was a cross\u2010sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self\u2010identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower\u2010middle\u2010income countries (45.1%). The median age was 30 (25\u221236) years old. For the PrEP use cascade, 82.2% (\n                      <jats:italic>n<\/jats:italic>\n                      = 11,427\/13,899) of participants were aware of PrEP, 35.0% (\n                      <jats:italic>n<\/jats:italic>\n                      = 4000\/11,427) had used it before and 70.1% (\n                      <jats:italic>n<\/jats:italic>\n                      = 2803\/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (\n                      <jats:italic>n<\/jats:italic>\n                      = 4068\/7427) PrEP\u2010na\u00efve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (\n                      <jats:italic>n<\/jats:italic>\n                      = 2996\/4068) of them expressed willingness to use PrEP and 83.0% (\n                      <jats:italic>n<\/jats:italic>\n                      = 2487\/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system\u2010level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual\u2010level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale\u2010up efforts. Future PrEP programmes should address system\u2010level barriers to support PrEP uptake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.26438","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T01:53:15Z","timestamp":1743385995000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["PrEP use and willingness cascades among GBMSM in 15 Asian countries\/territories: an analysis of the PrEP APPEAL survey"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0477-5749","authenticated-orcid":false,"given":"Gede Benny Setia","family":"Wirawan","sequence":"first","affiliation":[{"name":"Kirby Institute, UNSW  Sydney New South Wales Australia"},{"name":"Center for Public Health Innovation, Faculty of Medicine Udayana University  Denpasar 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Medicine Monash University  Melbourne Victoria Australia"},{"name":"Faculty of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Cassell","sequence":"additional","affiliation":[{"name":"FHI 360  Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Translational Medicine Monash University  Melbourne Victoria Australia"},{"name":"Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre Alfred Health  Melbourne Victoria Australia"},{"name":"China\u2010Australia Joint Research Center for Infectious Diseases School of Public Health Xi'an Jiaotong University Health Science Center  Shaanxi 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