Determinants of awareness and acceptability of HIV pre-exposure prophylaxis (PrEP) among men in Kenya

Although pre-exposure prophylaxis (PrEP) is prioritised for men at heightened risk of HIV, examining the determinants of PrEP awareness and acceptability among men in the general population is essential for informing inclusive and effective HIV prevention strategies in Kenya. We analyzed secondary data from the 2022 Kenya Demographic and Health Survey (KDHS), which comprised 14,402 men aged 18–54 years who were selected using a two-stage stratified sampling. Data were analysed using univariable and multivariable logistic regression analyses using SPSS (version 29). Overall, 49.3% (95% CI: 47.4–51.2) of men were aware of PrEP. Among those who were aware of PrEP, 68.7% (95% CI: 66.4–70.9) approved its use for HIV prevention. Factors independently associated with higher odds of PrEP awareness included completion of tertiary education (aOR 4.56, 95% CI: 2.89–7.18), belonging to the richest wealth quintile (aOR 2.36, 95% CI: 1.30–4.28), being HIV-positive (aOR 1.95, 95% CI: 1.36–4.45), and joint healthcare decision-making (aOR 14.18, 95% CI: 2.46–81.70). In contrast, living in Northeastern Kenya (aOR 0.19, 95% CI: 0.04–0.86) and belonging to other tribes in Kenya (aOR 0.50, 95% CI: 0.27–0.91) were associated with lower odds of PrEP awareness. On the other hand, having more than ten lifetime sexual partners (aOR 1.58, 95% CI: 1.02–2.44), not desiring more children (aOR 1.56, 95% CI: 1.08–2.27), and joint healthcare decision-making (aOR 25.69, 95% CI: 1.89–349.36) were associated with higher odds of PrEP acceptability/approval. Men who experienced controlling intimate partner violence (aOR 0.56, 95% CI: 0.39–0.79), those from the Kalenjin (aOR 0.23, 95% CI: 0.11–0.46), and those living in Northeastern region (aOR 0.19, 95% CI: 0.07–0.50) had lower odds of PrEP approval (aOR 5.39, 95% CI: 1.54–18.91). Although acceptability was high, PrEP awareness among men in Kenya remains lower compared to the acceptability level. These findings underscore the need for targeted, multi-level interventions, such as community-based education, culturally tailored messaging, expanded outreach in underserved regions, integration of IPV screening into PrEP services, and support for shared healthcare decision-making, to enhance PrEP awareness and equitable uptake among all men in Kenya.