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Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal

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Abstract

Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy that remarkably reduces HIV transmission risk. Although PrEP has been available in Nepal since 2019, very little is known about PrEP use among MSM in Nepal. This study aimed to examine PrEP awareness and its use among Nepali MSM and the factors influencing its adoption. A cross-sectional survey was conducted among MSM in Nepal between October and December 2022 (N = 250). Bivariate analysis and logistic regression were performed to determine factors associated with awareness and use of PrEP. In the study population, 59.6% of participants were aware of PrEP, however, only 30.4% of them had utilized it. The odds of PrEP awareness were higher among participants who had completed high school or above (aOR = 4.1; 95% CI = 1.8–9.6), those with health insurance coverage (aOR = 6.9; 95% CI = 2.1–22.3) and had tested for HIV (aOR = 21.2; 95% CI = 8.3–53.9). Similarly, participants who identified as gay (aOR = 3.4; 95% CI = 1.4–8.4), had visited a doctor within the past 6 months (aOR = 2.9; 95% CI = 1.2–6.5), had previously tested for HIV (aOR = 12.3; 95% CI = 3.4–44.7), and had been diagnosed with sexually transmitted infections (aOR = 7.0; 95% CI = 2.5–19.5) were more likely to have used PrEP. Our results highlight the critical importance of healthcare providers engaging in providing care for MSM, including facilitating as well as discussions about PrEP. In addition, there is a pressing need for innovative strategies (e.g., peer educators, social media, online facilitating technologies) to disseminate PrEP knowledge and reduce stigma surrounding PrEP.

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Data Availability

All the data used in this study can be obtained after reasonable request to corresponding author.

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Funding

We acknowledge financial support in part by a career development award from the National Institute on Drug Abuse (K01 DA051346) to Dr. Roman Shrestha. The funders had no role in study design, data collection, analysis, manuscript preparation, and decision to publish.

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Author notes

  1. Kiran Paudel and Manoj Panthi Kanak contributed equally and share equal authorship.

Authors and Affiliations

  1. Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal

    Kiran Paudel

  2. Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA

    Kiran Paudel, Kamal Gautam, Pablo Kokay Valente & Roman Shrestha

  3. Blue Diamond Society, Dhumbarahi Marg, Kathmandu, Nepal

    Manoj Panthi Kanak & Manisha Dhakal

  4. Institute of Medicine, Maharajgunj, Kathmandu, Nepal

    Prashamsa Bhandari

  5. Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, New Haven, CT, 06510, USA

    Jeffrey Wickersham & Roman Shrestha

  6. Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, 15261, USA

    Toan Ha

Authors
  1. Kiran Paudel
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Contributions

RS conceptualized and conducted the research. MPK, KP and RS performed the statistical analysis. MPK and KP prepared the first draft of the manuscript by taking the subsequential help of RS, PB, and KG. All the authors critically reviewed the manuscript and provided important inputs. RS supervised the study. All the authors read, reviewed, and agreed to the final version of the manuscript.

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Correspondence to Roman Shrestha.

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Paudel, K., Kanak, M.P., Gautam, K. et al. Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal. J Community Health 49, 514–525 (2024). https://doi.org/10.1007/s10900-023-01318-1

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