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<p>Despite the proven efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, uptake among men who have sex with men (MSM) in China remains low. Guided by the PrEP care cascade framework, we conceptualized PrEP literacy as a social practice shaped by structural and community dynamics, encompassing four dimensions: essential knowledge, eligibility self-assessment, access to medication, and adherence to follow-up care. We examine how social support, community norms, and structural barriers intersect to shape PrEP literacy disparities. A cross-sectional study was conducted in partnership with 20 community-based organizations (CBOs) across 20 Chinese cities (December 2023). We surveyed 1,400 MSM with an electronic questionnaire assessing demographics, sexual behaviors, PrEP-related norms, social support, and PrEP literacy using a validated 14-item scale aligned with the cascade framework. Multivariable logistic regression models were used to identify factors associated with PrEP literacy, adjusting for sociodemographic confounders. Participants exhibited stark disparities across PrEP literacy dimensions. Eligibility assessment proficiency was the lowest, with widespread misperceptions about clinical indications. Social-structural factors significantly predicted PrEP literacy: MSM reporting stronger PrEP-supportive norms (adjusted odds ratio [AOR] = 1.05, <i>p</i> &lt; 0.001) and social support (AOR = 1.03, <i>p</i> &lt; 0.001) had higher odds of adequate literacy. PrEP literacy gaps among Chinese MSM reflect structural inequities in health education and community-level misperceptions about eligibility. Interventions must address social-structural barriers through norm-driven, community-led strategies —peer navigation programs to reframe eligibility awareness and partnerships with CBOs to decentralize PrEP access. Policymakers should integrate PrEP literacy into national HIV prevention frameworks by leveraging China’s existing CBO infrastructure.</p>

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Structural and Social Drivers of Pre-Exposure Prophylaxis (PrEP) Literacy Disparities Among Men who have Sex with Men in China: A PrEP Care Cascade Analysis

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Mojun Ni,
  • Hao Lin,
  • Phoenix Kit-Han Mo,
  • Chun Chang,
  • Jinghua Li,
  • Wangnan Cao

摘要

Despite the proven efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, uptake among men who have sex with men (MSM) in China remains low. Guided by the PrEP care cascade framework, we conceptualized PrEP literacy as a social practice shaped by structural and community dynamics, encompassing four dimensions: essential knowledge, eligibility self-assessment, access to medication, and adherence to follow-up care. We examine how social support, community norms, and structural barriers intersect to shape PrEP literacy disparities. A cross-sectional study was conducted in partnership with 20 community-based organizations (CBOs) across 20 Chinese cities (December 2023). We surveyed 1,400 MSM with an electronic questionnaire assessing demographics, sexual behaviors, PrEP-related norms, social support, and PrEP literacy using a validated 14-item scale aligned with the cascade framework. Multivariable logistic regression models were used to identify factors associated with PrEP literacy, adjusting for sociodemographic confounders. Participants exhibited stark disparities across PrEP literacy dimensions. Eligibility assessment proficiency was the lowest, with widespread misperceptions about clinical indications. Social-structural factors significantly predicted PrEP literacy: MSM reporting stronger PrEP-supportive norms (adjusted odds ratio [AOR] = 1.05, p < 0.001) and social support (AOR = 1.03, p < 0.001) had higher odds of adequate literacy. PrEP literacy gaps among Chinese MSM reflect structural inequities in health education and community-level misperceptions about eligibility. Interventions must address social-structural barriers through norm-driven, community-led strategies —peer navigation programs to reframe eligibility awareness and partnerships with CBOs to decentralize PrEP access. Policymakers should integrate PrEP literacy into national HIV prevention frameworks by leveraging China’s existing CBO infrastructure.