Awareness, willingness to use and use of doxycycline post-exposure prophylaxis among gay, bisexual and other men who have sex with men in China: a national cross-sectional survey

Background Bacterial sexually transmitted infections (STIs) disproportionately impact gay, bisexual and other men who have sex with men (GBMSM) in China. Doxycycline post-exposure prophylaxis (DoxyPEP) can prevent syphilis and chlamydia among GBMSM; however, it has not yet been officially endorsed in China. This study aims to investigate the perceptions and use of DoxyPEP among GBMSM in a nationwide sample. Methods We conducted a nationwide online cross-sectional survey in China between November 2024 and February 2025. Participants were recruited through community-based organizations and Centers for Disease Control offices using convenience and snowball sampling. Eligible participants were cisgender GBMSM aged ≥18 years living in China. The survey assessed sociodemographic characteristics, sexual behaviors, and DoxyPEP awareness, willingness and use. Modified Poisson regression with robust variance estimation was used to identify correlates of DoxyPEP awareness, willingness and use. Results A total of 1022 GBMSM completed the survey (mean age 29 years); 96.9% identified as gay/bisexual. Most were unmarried (87.7%), had graduated college (87.8%) and had a monthly income >USD750 (68.3%). Overall, 55.1% had heard of DoxyPEP, 42.7% reported willingness to use it and 12.8% had previously used it. DoxyPEP awareness was associated with prior HIV pre-exposure prophylaxis (PrEP) use (aPR 1.47, 95% CI: 1.31–1.65) and recent sexual activity with female partners (aPR 1.42, 95% CI: 1.23–1.64). Willingness to use DoxyPEP was associated with multiple casual sexual partners (aPR 1.41, 95% CI: 1.15–1.73), commercial sex (aPR 1.31, 95% CI: 1.07–1.62), prior PrEP use (aPR 1.22, 95% CI: 1.05–1.41) and DoxyPEP awareness (aPR 2.12, 95% CI: 1.78–2.53). The most reported barriers were insufficient information (72.7%), concerns about side-effects (35.5%) and doubts about effectiveness (30.6%). DoxyPEP use was associated with multiple casual partners (aPR 2.17, 95% CI: 1.22–3.85), commercial sex (aPR 1.63, 95% CI: 1.07–2.47), prior PrEP use (aPR 2.56, 95% CI: 1.75–3.74) and DoxyPEP awareness (aPR 14.60, 95% CI: 6.12–34.80). Conclusions DoxyPEP awareness and willingness among GBMSM in China were moderate; however, actual uptake remained low. Having multiple sexual partners, commercial sex history, and prior HIV PrEP experience were associated with DoxyPEP willingness and use. Targeted health education and integration of DoxyPEP into existing HIV and STI prevention services may facilitate scaled uptake of DoxyPEP in practice.