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Int J STD AIDS. Author manuscript; available in PMC 2023 August 01.
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Published in final edited form as:

Int J STD AIDS. 2022 August ; 33(9): 821–828. doi:10.1177/09564624221106535.

Exploring drivers of pre-exposure prophylaxis uptake among

gay, bisexual, and other men who have sex with men in Malaysia
William H Eger1, Adeleye Adaralegbe2, Antoine Khati2, Iskandar Azwa3,4, Jeffrey A
Wickersham1,4, Sydney Osborne2, Roman Shrestha1,2,4,5
1Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New
Haven, CT, USA
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2Department of Allied Health Sciences, University of Connecticut, Mansfield, CT, USA

3Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
4Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya,
Kuala Lumpur, Malaysia
5Institute
for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut,
Mansfield, CT, USA

Abstract
Background: Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy,
particularly among men who have sex with men (MSM); however, PrEP uptake is below the
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threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia,
where same-sex sexual behavior is illegal.

Methods: A sample of 355 participants completed an online survey between June and July
2020, recruited through geosocial networking apps for MSM and social networking websites (e.g.
Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use
within this population.

Results: The sample was predominantly Malay (53.5%), had monthly incomes greater than RM
3000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants
heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the
adjusted multivariable logistic model, using drugs before or during sexual intercourse (“chemsex”)
(AOR: 3.37; 95% CI: 1.44–7.89), being diagnosed with a sexually transmitted infection in the last
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12 months (AOR: 2.08; 95% CI: 1.13–3.85), HIV testing in the previous 6 months (AOR: 3.23;

Corresponding author: William Eger, Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine,
135 College Street, Suite 323, New Haven, CT 06520-8056, USA. william.eger@yale.edu.
Author contributions
All authors (W.E., A.A., A.K., I.A., J.W., S.O., and R.S.) meet the criteria for authorship and have made substantial contributions to
various aspects of this manuscript. This manuscript was initially conceptualized by W.E., A.A., I.A., and R.S. and written by W.E. and
A.A. The formal analysis and methodology were completed by W.E. and A.A., with the help of R.S. Both A.A. and R.S. conducted
the initial investigation, with funding acquisition done by R.S. All other authors (A.K., J.W., and S.O.), in addition to those previously
mentioned, played substantial roles in the review and editing of each draft of the manuscript. All authors read and approved the final
manuscript.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
 Eger et al. Page 2

95% CI: 1.74–5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02–3.34) were
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associated with having taken PrEP in the past.

Conclusions: This study revealed that PrEP use among Malaysian MSM is relatively low,
despite high awareness, and is associated with healthcare engagement and high-risk behaviors.
These results highlight the need to tailor outreach activities for individuals at increased risk for
HIV and those disengaged with the health system.

Keywords
asia; high-risk behavior; prevention; human immunodeficiency virus; homosexual

Background
Pre-exposure prophylaxis (PrEP) for HIV is highly effective at preventing sexually acquired
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HIV infections, especially among men who have sex with men (MSM) 1 For this reason, the
World Health Organization (WHO) recommends that PrEP be used as a global prevention
strategy to decrease the burden of HIV among high-risk groups, including MSM.2 While
the incidence of HIV in the general population has been stable since 2005, MSM continue
to be disproportionately affected by new HIV infections, regardless of targeted prevention
programs 3,4

Though the higher rates of HIV in this group have been attributed to high-risk sexual
practices, including the frequent use of recreational drugs prior to sexual intercourse, and
lack of testing and PrEP awareness, the disproportionate burden of infections on MSM is
not solely due to individual-level factors.5,6 The risk of incident HIV infection is much
higher among MSM living in countries like Malaysia, where same-sex sexual behavior
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is criminalized, and lesbian, gay, bisexual, and transgender (LGBT) people face high
levels of stigmatization.7,8 Recent reports indicate that the HIV epidemic among MSM
in Malaysia is prolific, with prevalence increasing from 3.9% in 2009 to 21.6% in 2017.9,10
Although difficult to estimate the precise number of MSM in Malaysia with high accuracy,
the country’s 2019 Joint United Nations Programme on HIV/AIDS (UNAIDS) Progress
Report on HIV/AIDS projected that MSM will bear the greatest burden of HIV over
the next decade.9 Likewise, the use of recreational drugs common among MSM, such as
amphetamine-type stimulants and opioids, is criminalized.11,12 Stigmatization of LGBT
people and drug use have been associated with low uptake of preventive services for HIV
(e.g. PrEP, testing), exacerbating increases in incidence and morbidity.13

Despite advances in awareness of PrEP and its inclusion in Malaysia’s National Strategic
Plan to end AIDS by 2030, awareness about and willingness to initiate PrEP among MSM
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remains severely under-scaled.14 Studies of acceptability to initiate PrEP in Malaysia have

found positive associations between having multiple sex partners, prior knowledge of PrEP,
lack of confidence in practicing safer sex, having ever paid for sex with a male partner, and a
greater willingness to take PrEP.14 However, no studies have yet reported correlates of actual
PrEP use in this group. Given the increasing HIV vulnerability among Malaysian MSM,
it is crucial to understand what individual, community, and structural factors drive uptake
of PrEP in this population. Therefore, this study aims to assess the use of PrEP among

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Malaysian MSM, including factors associated with its uptake, to better tailor and strengthen
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HIV prevention efforts nationwide.

Methods
This cross-sectional study utilized an online survey of Malaysian MSM conducted in June
and July 2020. The survey sought to assess attitudes toward participation in an app-based
mobile health (mHealth) HIV prevention program. Eligibility criteria were: (i) being 18
years or older; (ii) identifying as male; (iii) self-reported HIV status as negative or unknown;
(iv) reporting recent (in the last 6 months) substance use or condomless sex; and (v) ability
to read and understand English or Bahasa Malaysia.

Sampling method
Participants were recruited using advertisements on geosocial networking apps (GSN)
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frequently used by MSM (e.g. Grindr, Hornet) and popular social networking websites for
the general population (e.g. Facebook). A convenience sampling method was used to recruit
MSM. The GSN apps pushed the advertisement to the chat inboxes of all users in Malaysia
while targeted banner advertisements were used on Facebook. These banners could show
up either as a static ad on the right-hand pane of the website or an ad that resembled a
standard post that users could encounter while scrolling through their feed. Clicking on the
advertisements directed interested persons to an eligibility screening tool and a brief online
consent form hosted by Qualtrics.

The consent form indicated that interested persons could enter a drawing to win one of
10 vouchers worth 635 Malaysian Ringgit (RM) [equivalent to 150 U.S. dollars (USD)]
and that there was “no participation necessary” to enter the random draw. The average
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completion time for the anonymous online survey was 10–12 minutes. The study protocol
was approved by the institutional review boards of the University of Malaya and Yale
University.

Study measures
Awareness of PrEP was assessed via the question “Before participating in this survey, have
you ever heard about PrEP, also known as pre-exposure prophylaxis?”, with the outcome
variable of interest being participants’ use of PrEP. To assess PrEP use, participants were
asked if they had ever used PrEP, with “Yes” or “No” as available responses. Predictor
variables were dichotomized (“Yes” or “No”) HIV risk behaviors of the participants in the
past 6 months: (i) sexual intercourse with another man; (ii) engagement in condomless sex;
(iii) engagement in group sex (i.e. sex with more than one other man); (iv) engagement
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in commercial (transactional) sex; (v) consistent condom use (defined as always using
condoms during anal sex); (vi) use of injection drugs; (vii) engagement in chemsex (i.e.
the use of recreational drugs (e.g. crystal methamphetamine/i.e. ketamine, ecstasy, and
gamma-hydroxybutyrate “G”) before or during sex; and (viii) the number of sexual partners,
coded as none, one, and more than one.

Perceived likelihood of HIV acquisition was assessed by asking: “What do you think is
your current risk of getting HIV?” Responses were dichotomized as “Low” and “High.”

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Participants were also asked if they had ever tested for HIV, including in the past 3, 6, and 12
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months. Recent sexually transmitted infection (STI) diagnosis was also assessed (in the past
12 months). All responses were dichotomized as “Yes” or “No.” Sociodemographic data of
the participants included age, ethnicity, income, relationship status, educational attainment,
sexual orientation, and disclosure of sexual orientation to family. All sociodemographic
variables except age were dichotomized, as shown in Table 1.

Data analysis
We followed a protocol based on published standards for removing potentially duplicate
cases while erring on the side of keeping rather than removing data in cases where a
determination could not be made. We first identified potential duplicates based on age,
sexual orientation, and ethnicity. All cases sharing those features were manually examined,
focusing on responses to other questions such as education, relationship status, income, and
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device and browser information, including survey duration.

We used IBM SPSS v27.0 for all data analyses. Frequencies and percentages were used
to describe categorical variables and means and standard deviations to describe continuous
variables. Bivariate Chi-square tests were used to compare differences between the outcome
(participants’ use of PrEP) and predictor variables. The statistical significance level was
set at 0.10 in the bivariate analyses testing sociodemographic and additional factors
hypothesized to be related to PrEP use.14–16 The final multivariable model included
variables with statistically significant p-values (i.e. p < .10) from the bivariate analysis,
barring awareness of PrEP which was removed from the final multivariable analysis due to
complete separation of data. Multicollinearity of the predictor variables was assessed, and
the assumption was not violated. Statistical significance in the final multivariable logistic
model was set to p < .05, with odds ratios, p-values, and corresponding confidence intervals
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used as indicators of significance. The goodness-of-fit of the final model was assessed using
Nagelkerke’s R square (R2) Test.17

Results
The recruitment period lasted for one month, and 1259 individuals engaged with the
survey, of which 592 (47.0%) consented and completed the screening tool. Two hundred
and twenty-seven (38.3%) out of the 592 who completed screening and met inclusion
criteria did not complete the survey; there was no significant difference between completers
and non-completers on any demographic factors. Four out of the 365 who completed the
survey failed attention and consistency validation checks (e.g. survey duration) and were
eliminated. Another six identified as female and were excluded from the analysis. The final
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sample size was 355.

Participants’ characteristics
Table 1 provides information on the sociodemographic and personal characteristics of the
sample. The mean age of participants was 33.1 (SD = 8.9) years. More than half of the
participants were Malays, and about 30% were Chinese. Most participants had a tertiary
level of education (84.5%), but only slightly more than half earned ≥3000 RM monthly

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(approximately USD 730). About three-quarters of participants identified as gay, and two-
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thirds were currently single. Almost 37% of the study population disclosed their sexual
orientation to their family members. A vast majority (77.2%) had ever tested for HIV, while
roughly 57% had been tested for HIV within the previous 6 months. Meanwhile, 27.0%
of participants had been diagnosed with a STI, other than HIV, in the last year and over one-
third (34.9%) considered themselves at risk of acquiring HIV. Among sociodemographic
characteristics, only income slightly related to PrEP use (p = .074).

As shown in Table 2, a majority of participants were aware of PrEP (80.8%) before study
enrollment, and all individuals that used PrEP in the past heard of it previously (p < .001).
Most participants (83.7%) engaged in anal intercourse with another man in the past 6
months, but among these individuals, 55.6% did not use condoms during the intercourse.
More than half of the participants had multiple sexual partners; however, only 35.2%
engaged in transactional anal sex. A small percentage (16.9%) of participants had been
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involved in group sex in the past 6 months. The use of injection drugs (in the past 6
months) was reported among 3.9% of participants, and about 12% used drugs before sexual
intercourse (“chemsex”).

Correlates of PrEP use

In this sample, PrEP had only ever been used by 18.3% of total participants. At the bivariate
level, group sex in the past 6 months (p = .006; OR: 2.51, 95% CI: 1.34–4.70), injection
drug use in the past 6 months (p = .027; OR: 3.59, 95% CI: 1.20–10.72), chemsex in the past
6 months (p < .001; OR: 4.80, 95% CI: 2.42–9.50), disclosure of sexual orientation to family
(p = .032; OR: 1.87, 95% CI: 1.08–3.22), HIV testing within the last 6 months (p < .001;
OR: 3.58, 95% CI: 2.02–6.35), and STI diagnosis in the last 12 months (p = .002; OR: 2.47,
95% CI: 1.41–4.33), were significantly associated with lifetime PrEP use (Table 2 and Table
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3).

Additionally, we examined the significant covariates independently associated with PrEP

use through multivariable logistic modeling (Table 3). Those who participated in chemsex
were 3.4 times as likely to have used PrEP (AOR: 3.37, 95% CI: 1.44–7.89) compared to
MSM who had not participated in chemsex. Participants who tested for HIV within the
last 6 months were over three times as likely to have used PrEP (AOR: 3.23, 95% CI:
1.74–5.99) than those who were not tested for HIV within the same period. Disclosure of
sexual orientation to family increased the likelihood of using PrEP almost twofold (AOR:
1.85, 95% CI: 1.02–3.34), as opposed to non-disclosure. Compared to those MSM that were
not diagnosed with an STI in the past 12 months, respondents diagnosed with an STI were
twice as likely to have used PrEP (AOR: 2.08, 95% CI: 1.13–3.85).
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Discussion
This is the first study to assess factors related to PrEP use among MSM in Malaysia.
Individual behaviors, such as sexual practices, drug use, and health services utilization,
played the largest role in engagement with PrEP, which aligns well with prior studies
examining willingness to use PrEP in this population.14 Unlike previous studies, however,

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social and ethnocultural factors hypothesized as significant predictors of PrEP use were not
related to PrEP uptake in this sample.18
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Although chemsex is traditionally associated with increased sexual risk-taking (e.g. group
sex, condomless sex) and STIs, including HIV, this study revealed that participants who
engage in chemsex are more likely to use PrEP.19 Interestingly enough, group sex (another
high-risk sexual practice) was also significantly associated with PrEP uptake in the
bivariate analysis, although insignificant in the final model. Despite mixed findings on the
associations between chemsex and PrEP use, this is not the first study to find a higher
utilization of health services for MSM engaging in chemsex.20 Multiple studies of MSM
across Europe revealed that most MSM that engaged in chemsex had attended a sexual
health clinic and had an HIV test done in the last year.21,22 Another study of GSN users on
Hornet (a GSN app marketed for gay men) in Mexico found a threefold higher odds of PrEP
use among chemsex participating users.23 Therefore, the finding that chemsex is associated
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with PrEP uptake is encouraging and not unfounded. Those individuals engaging in the
highest-risk sexual practices, such as condomless sex or group sex, were the most likely to
use PrEP to prevent HIV. A prior study done in France and Canada, for example, revealed
that participants reporting chemsex had a higher HIV risk perception, which may lend itself
to this finding.24 While perceived risk does not always translate into changed behavior,25
it was clear that there was some association with actual risk and PrEP uptake. It appears
that MSM who engage in chemsex may have a high degree of self-awareness of their risk
behavior, particularly their drug use, which may motivate them to engage in health services
and get a PrEP prescription.

Similar to other studies, those who recently received health care services, such as
through an HIV test in the previous 6 months, were significantly more likely to have
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used PrEP – a medication that requires a provider prescription.26, 27 Prior research has
shown that engagement with health care services is associated with positive or improved
HIV prevention and treatment outcomes.26 Unfortunately, uptake of HIV testing among
Malaysian MSM has remained relatively modest (~70.4%), well below the 90% target
declared by the United Nations.28 In our study, recent HIV testing (in the past 6 months
or earlier) was markedly lower, indicating a potentially lower uptake of health services in
general. While we cannot determine the temporal relationship between HIV testing and
PrEP use – for example, if testing to initiate or remain on PrEP was the cause of this
association – this finding still emphasizes the importance of expedited engagement to care
for marginalized populations, such as MSM.

Like participating in recent HIV testing, diagnosis with an STI was significantly related to
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uptake of PrEP in this population. Although not assessed through temporal mechanisms,
we hypothesize that initial engagement with STI testing may lead individuals to be more
involved in the health care system and subsequently more likely to speak to their providers
about PrEP. On the other hand, it is possible that being on PrEP could have discouraged
condom usage due to a perception that PrEP provides protection for other STIs, not just
HIV.29 While this is possible, the over-whelming benefits of PrEP cannot be overshadowed
and further longitudinal research in this context must be conducted. As a preventive strategy,
programs looking to optimize PrEP uptake among MSM in Malaysia may also highlight the

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importance of frequent STI testing while taking PrEP. Additionally, prior research has shown
that being diagnosed with an STI is associated with recent and incident HIV infections.30
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This connection to HIV acquisition, in addition to associations with a greater number of

sexual partners, group sex, and injection drug use might alert providers that PrEP may be
warranted.29 With this in mind, prioritizing connection to PrEP services for individuals that
receive a positive diagnosis with an STI might be a meaningful strategy to ensure that
high-risk MSM receive PrEP in a timely manner.31

As also found by How Lim et al., disclosure of sexual orientation was significantly
associated with an increased likelihood of PrEP uptake.14 Outward disclosure of one’s
sexual orientation may be associated with an increased likelihood of engaging with health
services and making individuals more open to sharing their sexual practices with family,
friends, and healthcare providers.32 It might also decrease reluctance to discuss PrEP
use with partners and providers while diminishing the likelihood of engaging in unsafe
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behaviors.33 MSM who do not hide their sexuality are reported to seek out less high-risk
behaviors to engage in sexual practices favorable to them. Meanwhile, structural factors,
such as the illegalization of same-sex sexual behavior in Malaysia, may impact the ability
for men to disclose their sexual orientation.34 Thus, not having the ability to disclose their
sexual orientation in a safe environment could potentially be exacerbating the HIVepidemic
within the MSM community in Malaysia.

As with any study, there were several limitations. Our study used convenience sampling
through advertisements on GSN apps for MSM and social networking websites for the
general population. This sampling method likely allowed us to get a relatively representative
sample of MSM in Malaysia but may have missed individuals not involved in these
platforms. Coupled with access issues, responses may have been influenced by social
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desirability or recall biases which are common issues relevant to cross-sectional studies.
Likewise, due to the nature of the study, we could not assess causal mechanisms for PrEP
uptake that would have been available in a longitudinal study. For example, we could not
temporally assess the true association between STI diagnosis and PrEP use. Similarly, our
survey only assessed lifetime PrEP uptake, which may have resulted in different findings
than a study of recent or current PrEP use. Because we did not assess recent or current PrEP
use, our conclusions may not translate well into determining factors that predict readiness
or general willingness to initiate PrEP for the prevention of sexual risk. Overall, the small
sample size and the small number of participants reporting PrEP use may have introduced
type-2 errors (not detecting a significant, true association), which could have impacted
our results. Although we slightly overrepresented individuals pursuing a tertiary level of
education in Malaysia, which may have resulted in an artifactually high level of awareness,
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we still captured a substantial number of responses from individuals with lower educational
attainment.35 Despite these limitations, we believe that our study’s strengths far outweigh its
limitations. The insights provided on the drivers of PrEP use among MSM in Malaysia will
be profoundly valuable for alleviating the burden of the HIV epidemic and tailoring public
health programs related to PrEP within this context.

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Conclusion
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As several countries in the Asia Pacific region embark on nationwide PrEP implementation,
the implications for this study are paramount.36 PrEP can be a valuable tool for preventing
HIV among key populations, including MSM, who are at increased risk of HIV infection
due to various individual (e.g. high-risk sexual practices), provider (e.g. stigmatization), and
structural (e.g. the illegality of same-sex sexual behavior) factors. This study revealed that
utilization of PrEP among MSM in Malaysia is alarmingly low, despite high awareness. It
appears that awareness alone is insufficient in increasing PrEP uptake; however, targeted
behavioral interventions could enhance the HIV prevention landscape in Malaysia. Our
findings highlight the need for better public health programming around PrEP and other
HIV risk reduction strategies among MSM in Malaysia and the need for tailored programs
for individuals who may be at increased risk. Existing services should focus on strategies
that will decrease stigma around PrEP and HIV-related services and provide an environment
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where MSM can disclose their sexuality. Ultimately, any national program to halt the HIV
epidemic in Malaysia should focus on expediting care and testing for MSM with an elevated
risk of HIV infection and the importance of inclusive educational programming that further
empowers MSM to disclose their sexuality safely.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of
this article: This work was supported by the a grant from the National Institute on Drug Abuse (K01 DA051346 for
RS).

Abbreviations
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AIDS Acquired Immunodeficiency Syndrome

GSN Geosocial Networking Apps

HIV Human immunodeficiency virus

mHealth Mobile Health

MSM Men who have sex with men

OR Odds ratio

PrEP Pre-exposure prophylaxis for HIV

PWID People who inject drugs

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RM Malaysian Ringgit

STI Sexually transmitted infection

UMREC University of Malaya Research Ethics Committee

USD United States Dollar

WHO World Health Organization

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Table 1.
a
Sociodemographic characteristics of Malaysian MSM, stratified by PrEP use (N = 355) .
Eger et al.

Sociodemographic characteristics b b b χ2 Df P
Total n (%) Never used PrEP n (%) Used PrEP n (%)

Age (years): Mean (±SD) 33.1 (±8.9) 32.7 (±9.0) 35.1 (±8.2) — 353 .129
Ethnicity
Malay 190 (53.5) 158 (83.2) 32 (16.8) 1.972 2 .373
Chinese 106 (29.9) 82 (77.4) 24 (22.6)
Other 59 (16.6) 50 (84.7) 9 (15.3)
Income
< RM 3000 168 (47.3) 144 (85.7) 24 (14.3) 3.453 1 .074
≥ RM 3000 187 (52.7) 146 (78.1) 41 (21.9)
c
Education
Secondary and below 55 (15.5) 48 (87.3) 7 (12.7) 1.356 1 .342
Tertiary 300 (84.5) 242 (80.7) 58 (19.3)
Relationship status
Single 238 (67.0) 198 (83.2) 40 (16.8) 1.091 1 .309
In a relationship 117 (33.0) 92 (78.6) 25 (21.4)
Sexual orientation
Gay 263 (74.1) 212 (80.6) 51 (19.4) 2.365 2 .307
Bisexual 77 (21.7) 67 (87.0) 10 (13.0)
Other 15 (4.2) 11(73.3) 4 (26.7)

Int J STD AIDS. Author manuscript; available in PMC 2023 August 01.
MSM: men who have sex with men; PrEP: pre-exposure prophylaxis; p: p-value; SD: Standard Deviation; RM: Malaysian Ringgit.
a
Table values are n and (%) for categorical variables and mean and standard deviation (SD) for continuous variables.
b
Numbers may not sum to total due to missing data, and percentages may not sum to 100% due to rounding.
c
Secondary education is defined as post-primary education ending in 5 years (ages 13–18); tertiary education is any education post-secondary education, such as university.
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Table 2.
a
Behavioral correlates of PrEP use among Malaysian MSM .
Eger et al.

HIV risk behaviors (In the past 6 months) Total b b χ2 df c

Never used PrEP n (%) Used PrEP n (%) p

Anal sex with another man

No 85 (16.3) 74 (87.1) 11 (12.9) 2.154 1 .152
Yes 270 (83.7) 216 (80.0) 54 (20.0)
Condomless sex
No 120 (44.4) 98 (81.7) 22 (18.3) 0.375 1 .646
Yes 150 (55.6) 118 (78.7) 32 (21.3)
Consistent condom use
No 150 (55.6) 118 (78.7) 32 (21.3) 0.375 1 .646
Yes 120 (44.4) 98 (81.7) 22 (18.3)
Number of sexual partners
0 85 (23.9) 74 (87.1) 11 (12.9) 3.617 2 .164
1 72 (20.3) 61 (84.7) 11 (15.3)
>1 198 (55.8) 155 (78.3) 43 (21.7)
Transactional sex
No 230 (64.8) 186 (80.9) 44 (19.1) 0.294 1 .667
Yes 125 (35.2) 104 (83.2) 21 (16.8)
Group sex
No 295 (83.1) 249(84.4) 46 (15.6) 8.612 1 .006
Yes 60 (16.9) 41(68.3) 19 (31.7)

Int J STD AIDS. Author manuscript; available in PMC 2023 August 01.
Injection drug use
No 341 (96.1) 282 (82.7) 59 (17.3) 5.872 1 .027
Yes 14 (3.9) 8 (57.1) 6 (42.9)
d
Chemsex
No 313 (88.2) 267 (85.3) 46 (14.7) 23.094 1 <.001
Yes 42 (11.8) 23 (54.8) 19 (45.2)
Perceived likelihood of HIV acquisition
No 231 (65.1) 191 (82.7) 40 (17.3) 0.437 1 .565
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HIV risk behaviors (In the past 6 months) Total b b χ2 df c

Never used PrEP n (%) Used PrEP n (%) p
Yes 124 (34.9) 99 (79.8) 25 (20.2)
Disclosed sexual orientation to family
Eger et al.

No 224 (63.1) 191 (85.3) 33 (14.7) 5.195 1 .032

Yes 131 (36.9) 99 (75.6) 32 (24.4)
Testing behaviors
HIV Tested – lifetime
No 81 (22.8) 80 (98.8) 1 (1.2) 20.457 1 <.001
Yes 274 (77.2) 210 (76.6) 64 (23.4)
HIV Tested – last 3 months
No 281 (79.1) 238 (84.7) 43 (15.3) 8.151 1 .007
Yes 74 (20.9) 52 (70.3) 22 (29.7)
HIV Tested – last 6 months
No 204 (57.5) 183 (89.7) 21 (10.3) 20.602 1 <.001
Yes 151(42.5) 107 (70.9) 44 (29.1)
HIV Tested – last 12 months
No 140 (39.4) 132 (94.3) 8 (5.7) 24.519 1 <.001
Yes 215 (60.6) 158 (73.5) 57 (26.5)
STI diagnosis – last 12 months
No 259 (73.0) 222 (85.7) 37 (14.3) 10.369 1 .002
Yes 96 (27.0) 68 (70.8) 28 (29.2)
Aware of PrEP
No 68 (19.2) 68 (100.0) 0 (0.0) 18.85 1 <.00
Yes 287 (80.8) 222 (77.4) 65 (22.6)

Int J STD AIDS. Author manuscript; available in PMC 2023 August 01.
MSM: men who have sex with men; PrEP: preexposure prophylaxis; df: degrees of freedom; χ2: chi-square; p: p-value.
a
Table values are n and (%) for categorical variables.
b
Numbers may not sum to total due to missing data, and percentages may not sum to 100% due to rounding.
c
p-value is for the chi-square (χ2) test.
d
Chemsex is defined as the use of recreational drugs before anal sex.
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Table 3.
a
Results of Multivariable Logistic Regression Model Predicting PrEP use among Malaysian MSM .
Eger et al.

Variables OR (95% CI) AOR (95% CI) c

P

Group sex in past 6 months 2.51 (1.34–4.70) 1.25 (0.61–2.57) .548

Injection drug use in past 6 months 3.59 (1.20–10.72) 1.52 (0.38–6.04) .556
b 4.80 (2.42–9.50) 3.37 (1.44–7.89) .005
Chemsex in past 6 months
STI diagnosis – last 12 months 2.47 (1.41–4.33) 2.08 (1.13–3.85) .019
HIV tested – last 6 months 3.58 (2.02–6.35) 3.23 (1.74–5.99) <.001
Disclosed sexual orientation to family 1.87 (1.08–3.22) 1.85 (1.02–3.34) .042
Income > RM 3000 0.59 (0.34–1.03) 0.71 (0.39–1.30) .266
d — 0.21 —
Nagelkerke’s R2

MSM: men who have sex with men; PrEP: pre-exposure prophylaxis; OR: unadjusted odds ratio; CI: confidence interval; AOR: adjusted odds ratio; p: p-value.
a
OR predictions are predicting lifetime PrEP use.
b
Chemsex is defined as the use of recreational drugs before anal sex.
c
p-value for the final adjusted multivariable model.
d 2
R is for the final adjusted multivariable model.

Int J STD AIDS. Author manuscript; available in PMC 2023 August 01.
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