P292: PrEP-related experiences, doubts, and stigma among MSM in China: Results from a qualitative study.

Background: HIV oral pre-exposure prophylaxis (PrEP) was approved by the Chinese National Medical Products Administration (NMPA) in 2020. However, the experiences of PrEP use among Chinese men who have sex with men (MSM) remain unclear. We purposefully sampled MSM with various PrEP use history from a PrEP demonstration project in Guangzhou, China, to their PrEP use experiences and perspectives on PrEP related stigma. Methods: Based on the self-reported PrEP use history and current adherence in quarterly follow-up surveys, we conducted one-to-one semi-structured in-depth interviews with a purposeful sample of MSM on daily PrEP in Guangzhou, China. We recruited MSM who 1) completely discontinued, 2) continuously using PrEP with different levels of selfreported adherence, 3) intermittently using PrEP. We also sampled MSM using an on-demand dosing strategy. The interview guide included questions on PrEP using experience, perceived barriers, and facilitators to PrEP initiation, continuation, and discontinuation. All interviews were conducted in Chinese by native speakers, in-person or online. We then conducted a thematic analysis with an iterative inductive and deductive coding process using Dedoose. Results: Participants mainly viewed PrEP as an additional protection to using condoms. Positive experiences include reducing HIV-related anxieties and concerns about irrational behaviors such as unplanned sex. However, participants expressed doubts about PrEP regarding how it was commercialized in social media and that PrEP is not 100% efficacious. Some participants viewed PrEP as a class status for those with higher socioeconomic status due to its financial barrier, while others weighed on the importance of official approval of the drug to trust it. Experiences of stigma included 1): PrEP is linked to promiscuity; 2): PrEP is mistaken for ART; 3): PrEP could lead to the disclosure of sexual orientation. Participants also reported concealment of PrEP in response to stigma and hopes for a more stable form of PrEP such as long acting injectables. Conclusion: Patient education, especially when provided by credible organizations, about PrEP efficacy and side effects management is key to reducing misinformation and doubts about PrEP. Structural interventions, including destigmatizing HIV, PrEP, and minority groups, are highly needed to achieve the sustainability of PrEP implementation. [ABSTRACT FROM AUTHOR]