{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:11:14Z","timestamp":1788923474269,"version":"build-2803163510"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010816","name":"Anhui Provincial Department of Science and Technology","doi-asserted-by":"publisher","award":["1604F0804040"],"award-info":[{"award-number":["1604F0804040"]}],"id":[{"id":"10.13039\/501100010816","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Men who have sex with men (MSM) are disproportionately affected by HIV and represent the primary target population for pre-exposure prophylaxis (PrEP) use. However, PrEP adoption in China remains limited, partly due to its late regulatory approval. This study aims to investigate the awareness and willingness of PrEP use and associated factors among MSM in Maanshan city, so as to promote the popularization of PrEP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This cross-sectional study was conducted in Maanshan City, China, between June 2016 and December 2019. Participants completed the questionnaire through respondent-driven sampling (RDS). The questionnaire information was organized and analyzed using SPSS 23.0 software. Both univariate and multivariate logistic regression models were employed to investigate the determinants of PrEP willingness and awareness among HIV-negative MSM.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 879 participants were enrolled, with 837 providing analyzable data. The majority (62.25%) were aged &lt;30 years old, with 97.49% self-identified as homosexual. Among participants, 50.18% reported regular male sexual partners. Regarding sexual behaviors, 71.80% of MSM engaged in casual sex and 36.56% unprotected anal sex (UAI) within the last six months. HIV awareness was reported by 92.83% of respondents, while PrEP awareness was substantially lower (22.70%). Willingness to use PrEP was high (89.49%), with 16.49% preferring to take PrEP daily and 84.59% preferring to take PrEP on demand. Multivariate logistic regression revealed that vocational school (vs. high school or below), recent casual sex engagement, PrEP awareness, and recent UAI history were significant predictors of PrEP willingness. Higher education (university or above vs. high school or below), versatile sexual role (vs. op\/insertive ones), recent casual sex and prior HIV testing were positively associated with PrEP awareness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Maanshan\u2019s MSM population demonstrated high PrEP acceptance but limited awareness. The findings suggest that expanding access to HIV testing could enhance PrEP awareness. Simultaneously, PrEP dissemination combined with targeted HIV prevention may effectively reduce HIV transmission in the MSM population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0324259","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T17:38:58Z","timestamp":1747935538000},"page":"e0324259","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Awareness and willingness to utilize HIV pre-exposure prophylaxis and associated factors among men who have sex with men in Maanshan, China"],"prefix":"10.1371","volume":"20","author":[{"given":"Quan","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gan","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qisheng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8748-8082","authenticated-orcid":true,"given":"Yinguang","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qirong","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"issue":"7","key":"pone.0324259.ref001","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1007\/s10508-018-1207-6","article-title":"Prospective predictors of multiple sexual partners among African American men who have sex with men","volume":"47","author":"D Chittamuru","year":"2018","journal-title":"Arch Sex Behav"},{"issue":"48","key":"pone.0324259.ref002","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.46234\/ccdcw2021.249","article-title":"Research progress in the epidemiology of HIV\/AIDS in China","volume":"3","author":"N He","year":"2021","journal-title":"China CDC Wkly"},{"issue":"3","key":"pone.0324259.ref003","first-page":"247","article-title":"Analysis on HIV\/AIDS epidemic situation and prospect of prevention and control in China","volume":"29","author":"M Han","year":"2023","journal-title":"Chin J AIDS STD"},{"key":"pone.0324259.ref004","volume-title":"Guidance on Pre-Exposure Oral Prophylaxis (PrEP) for Serodiscordant Couples, Men and Transgender Women Who Have Sex with Men at High Risk of HIV: Recommendations for Use in the Context of Demonstration Projects","author":"WHO Guidelines Approved by the Guidelines Review Committee","year":"2012"},{"issue":"23","key":"pone.0324259.ref005","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1056\/NEJMoa1506273","article-title":"On-demand preexposure prophylaxis in men at high risk for HIV-1 infection","volume":"373","author":"J-M Molina","year":"2015","journal-title":"N Engl J Med"},{"key":"pone.0324259.ref006","author":"PreventionCFDCa","year":"2021"},{"issue":"12","key":"pone.0324259.ref007","doi-asserted-by":"crossref","DOI":"10.3346\/jkms.2018.33.e91","article-title":"Awareness and acceptance of HIV pre-exposure prophylaxis among medical personnel and men who have sex with men in Korea","volume":"33","author":"HH Chang","year":"2018","journal-title":"J Korean Med Sci"},{"issue":"1","key":"pone.0324259.ref008","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s12981-021-00374-8","article-title":"Willingness to use HIV pre-exposure prophylaxis and associated factors among men who have sex with men in Liuzhou, China","volume":"18","author":"Y Fu","year":"2021","journal-title":"AIDS Res Ther"},{"issue":"12","key":"pone.0324259.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226384","article-title":"Awareness, willingness to use, and history of HIV PrEP use among gay, bisexual, and other men who have sex with men in Nigeria","volume":"14","author":"A Ogunbajo","year":"2019","journal-title":"PLoS One"},{"issue":"27","key":"pone.0324259.ref010","doi-asserted-by":"crossref","first-page":"597","DOI":"10.15585\/mmwr.mm6827a1","article-title":"Changes in HIV preexposure prophylaxis awareness and use among men who have sex with men - 20 urban areas, 2014 and 2017","volume":"68","author":"T Finlayson","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"13","key":"pone.0324259.ref011","first-page":"292","article-title":"Analysis of knowledge level and use of antiretroviral pre-exposure and post-exposure prophylaxis among MSM - China, 2019-2022","volume":"5","author":"J Guo","year":"2023","journal-title":"China CDC Wkly"},{"issue":"10","key":"pone.0324259.ref012","first-page":"1230","article-title":"Meta analysis of the willingness of pre-exposure prophylaxis among high-risk population of HIV in China","volume":"28","author":"Y Zheng","year":"2022","journal-title":"Chin J AIDS STD"},{"issue":"11","key":"pone.0324259.ref013","first-page":"1266","article-title":"A meta-analysis of factors related to the intention to use HIV pre-exposure prophylaxis in Chinese MSM","volume":"29","author":"L Li","year":"2023","journal-title":"Chin J AIDS STD"},{"issue":"1","key":"pone.0324259.ref014","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1071\/SH16099","article-title":"Global travel and HIV\/STI epidemics among MSM: what does the future hold?","volume":"14","author":"VC Lee","year":"2017","journal-title":"Sex Health"},{"issue":"1","key":"pone.0324259.ref015","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12981-023-00539-7","article-title":"HIV associated factors among men who have sex with men in Maanshan, China: a cross-sectional study","volume":"20","author":"Q-R Qin","year":"2023","journal-title":"AIDS Res Ther"},{"key":"pone.0324259.ref016","doi-asserted-by":"crossref","first-page":"806600","DOI":"10.3389\/fpubh.2022.806600","article-title":"Trends in HIV prevalence and HIV-related risk behaviors among male students who have sex with men from 2016 to 2020 in Nanjing, China: consecutive cross-sectional surveys","volume":"10","author":"Y Xu","year":"2022","journal-title":"Front Public Health"},{"issue":"12","key":"pone.0324259.ref017","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1177\/0956462415606251","article-title":"Consistently high HIV prevalence among men who have sex with men in Chengdu city from 2009 to 2014","volume":"27","author":"D Zhenhua","year":"2016","journal-title":"Int J STD AIDS"},{"issue":"3","key":"pone.0324259.ref018","first-page":"511","article-title":"Discrepancy between behavioral-indicated and perceived candidacy for HIV pre-exposure prophylaxis among men who have sex with men in Chengdu, China","volume":"55","author":"H Lin","year":"2023","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban"},{"key":"pone.0324259.ref019","article-title":"Using a geosocial networking app to investigate new HIV infections and related risk factors among student and nonstudent men who have sex with men in Chengdu, China: open cohort study","volume":"25","author":"Z Dai","year":"2023","journal-title":"J Med Internet Res"},{"issue":"1","key":"pone.0324259.ref020","doi-asserted-by":"crossref","first-page":"16003","DOI":"10.1038\/s41598-018-33570-0","article-title":"A modeling study of the Danish HIV epidemic in men who have sex with men: travel, pre-exposure prophylaxis and elimination","volume":"8","author":"L Palk","year":"2018","journal-title":"Sci Rep"},{"issue":"24","key":"pone.0324259.ref021","first-page":"3381","article-title":"Analysis on epidemiological characteristics of AIDS in Ma\u2019anshan city from 1999-2020","volume":"38","author":"Q Qing","year":"2022","journal-title":"Occup Health"},{"key":"pone.0324259.ref022","author":"Sciences G","year":"2020"},{"issue":"3","key":"pone.0324259.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0032329","article-title":"Willingness to accept HIV pre-exposure prophylaxis among Chinese men who have sex with men","volume":"7","author":"F Zhou","year":"2012","journal-title":"PLoS One"},{"issue":"3","key":"pone.0324259.ref024","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1089\/apc.2012.0412","article-title":"Attitudes toward HIV pre-exposure prophylaxis among men who have sex with men in western China","volume":"27","author":"Y Zhang","year":"2013","journal-title":"AIDS Patient Care STDS"},{"issue":"3","key":"pone.0324259.ref025","article-title":"Increasing awareness of HIV pre-exposure prophylaxis (PrEP) and willingness to use HIV PrEP among men who have sex with men: a systematic review and meta-analysis of global data","volume":"25","author":"Z Sun","year":"2022","journal-title":"J Int AIDS Soc"},{"key":"pone.0324259.ref026","author":"WHO","year":"2012"},{"issue":"2","key":"pone.0324259.ref027","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5582\/bst.2016.01035","article-title":"Low willingness and actual uptake of pre-exposure prophylaxis for HIV-1 prevention among men who have sex with men in Shanghai, China","volume":"10","author":"Y Ding","year":"2016","journal-title":"Biosci Trends"},{"issue":"4","key":"pone.0324259.ref028","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/OLQ.0000000000000965","article-title":"Monitoring HIV preexposure prophylaxis use among men who have sex with men in Washington State: findings from an internet-based survey","volume":"46","author":"DW Rao","year":"2019","journal-title":"Sex Transm Dis"},{"issue":"12","key":"pone.0324259.ref029","doi-asserted-by":"crossref","first-page":"3879","DOI":"10.1007\/s10461-018-2181-7","article-title":"Assessing HIV stigma on prevention strategies for black men who have sex with men in the United States","volume":"22","author":"JM Sang","year":"2018","journal-title":"AIDS Behav"},{"issue":"5","key":"pone.0324259.ref030","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1007\/s10461-016-1619-z","article-title":"Awareness and acceptability of pre-exposure HIV prophylaxis among men who have sex with men in Baltimore","volume":"21","author":"SA Fallon","year":"2017","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0324259.ref031","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/QAI.0000000000000858","article-title":"Bone mineral density changes among young, healthy African women receiving oral tenofovir for HIV preexposure prophylaxis","volume":"71","author":"BG Mirembe","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"10","key":"pone.0324259.ref032","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1007\/s001980170033","article-title":"Pregnancy and lactation confer reversible bone loss in humans","volume":"12","author":"C Karlsson","year":"2001","journal-title":"Osteoporos Int"},{"key":"pone.0324259.ref033","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s11657-015-0206-7","article-title":"Factors associated with bone mineral density in healthy African women","volume":"10","author":"NM Mgodi","year":"2015","journal-title":"Arch Osteoporos"},{"issue":"5","key":"pone.0324259.ref034","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1056\/NEJMoa1110711","article-title":"Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana","volume":"367","author":"MC Thigpen","year":"2012","journal-title":"N Engl J Med"},{"issue":"12","key":"pone.0324259.ref035","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1097\/QAD.0000000000001145","article-title":"Effectiveness and safety of oral HIV preexposure prophylaxis for all populations","volume":"30","author":"VA Fonner","year":"2016","journal-title":"AIDS"},{"issue":"6","key":"pone.0324259.ref036","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1097\/00002030-200304110-00027","article-title":"Could chemoprophylaxis be used as an HIV prevention strategy while we wait for an effective vaccine?","volume":"17","author":"M Youle","year":"2003","journal-title":"AIDS"},{"issue":"2","key":"pone.0324259.ref037","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1517\/14740338.2016.1128412","article-title":"Safety of oral tenofovir disoproxil fumarate-based pre-exposure prophylaxis for HIV prevention","volume":"15","author":"KK Mugwanya","year":"2016","journal-title":"Expert Opin Drug Saf"},{"key":"pone.0324259.ref038","doi-asserted-by":"crossref","first-page":"19973","DOI":"10.7448\/IAS.18.4.19973","article-title":"Translating PrEP effectiveness into public health impact: key considerations for decision-makers on cost-effectiveness, price, regulatory issues, distributive justice and advocacy for access","volume":"18","author":"C Hankins","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"2","key":"pone.0324259.ref039","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1007\/s11904-018-0385-0","article-title":"PrEP stigma: implicit and explicit drivers of disparity","volume":"15","author":"SA Golub","year":"2018","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"10","key":"pone.0324259.ref040","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1007\/s10461-019-02561-1","article-title":"Factors Associated with PrEP support and disclosure among YMSM and transgender individuals assigned male at birth in Chicago","volume":"23","author":"G Phillips","year":"2019","journal-title":"AIDS Behav"},{"issue":"9","key":"pone.0324259.ref041","doi-asserted-by":"crossref","first-page":"3044","DOI":"10.1007\/s10461-018-2159-5","article-title":"Geographic and individual associations with PrEP stigma: results from the RADAR cohort of diverse young men who have sex with men and transgender women","volume":"22","author":"B Mustanski","year":"2018","journal-title":"AIDS Behav"},{"key":"pone.0324259.ref042","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1080\/09540121.2020.1739207","article-title":"Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men","volume":"32","author":"JA Kelly","year":"2020","journal-title":"AIDS Care"},{"issue":"4","key":"pone.0324259.ref043","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1007\/s11904-010-0062-4","article-title":"Implementation science of pre-exposure prophylaxis: preparing for public use.","volume":"7","author":"K Underhill","year":"2010","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"pone.0324259.ref044","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1186\/s12889-020-08488-w","article-title":"Low willingness to pay for pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in China","volume":"20","author":"W Cao","year":"2020","journal-title":"BMC Public Health"},{"key":"pone.0324259.ref045","author":"Control CfD","year":"2020"},{"issue":"3","key":"pone.0324259.ref046","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25461","article-title":"National trends in HIV pre-exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017","volume":"23","author":"PS Sullivan","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0324259.ref047","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/QAD.0000000000001658","article-title":"Costs and benefits of on-demand HIV preexposure prophylaxis in MSM","volume":"32","author":"I Durand-Zaleski","year":"2018","journal-title":"AIDS"},{"issue":"12","key":"pone.0324259.ref048","doi-asserted-by":"crossref","DOI":"10.1097\/QAD.0000000000001141","article-title":"Preexposure prophylaxis on-demand dramatically reduces HIV incidence in MSM","volume":"30","author":"KN Harper","year":"2016","journal-title":"AIDS"},{"issue":"4","key":"pone.0324259.ref049","first-page":"425","article-title":"Application and challenge of pre-exposure prevention and post-exposure prevention of AIDS","volume":"25","year":"2019","journal-title":"Chin J AIDS STD"},{"issue":"1","key":"pone.0324259.ref050","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1186\/s12879-018-3516-8","article-title":"A mathematical model of biomedical interventions for HIV prevention among men who have sex with men in China","volume":"18","author":"J Li","year":"2018","journal-title":"BMC Infect Dis"},{"key":"pone.0324259.ref051","author":"UNAIDS","year":"2018"},{"issue":"7","key":"pone.0324259.ref052","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1007\/s10461-024-04336-9","article-title":"Awareness of U\u2009=\u2009U among sexual and gender minorities in Brazil, Mexico, and Peru: differences according to self-reported HIV status","volume":"28","author":"KA Konda","year":"2024","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0324259.ref053","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25466","article-title":"\u201cI just believe there is a risk\u201d understanding of undetectable equals untransmissible (U = U) among health providers and HIV-negative partners in serodiscordant relationships in Kenya","volume":"23","author":"K Ngure","year":"2020","journal-title":"J Int AIDS Soc"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324259","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T17:39:07Z","timestamp":1747935547000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0324259"}},"subtitle":[],"editor":[{"given":"Daniel","family":"Demant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0324259","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}