Objective To understand the willingness to use human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), the channels of knowledge acquisition, and the preferences for promotion policies/strategies among men who have sex with men (MSM) in Guangxi, and to analyze the factors influencing their willingness to use such prophylaxis. Methods Participants are recruited through an AIDS prevention social organization for MSM in Guangxi using non-probability sampling. Data were collected via a questionnaire survey. Univariate analysis of factors associated with PrEP/PEP willingness was performed using chi-square or corrected chi-square tests. Independent influencing factors were identified using multivariate logistic regression. Knowledge channels and policy preferences were assessed via multiple response analysis. Results A total of 300 valid questionnaires were retrieved. Among the respondents, 83.67% (251/300) expressed willingness to use PrEP, and there were statistically significant differences in the willingness to use PrEP among groups with different ages, educational backgrounds, marital statuses, and levels of knowledge about PrEP (all P<0.05); 84.33% (253/300) were willing to use PEP, and statistically significant differences in the willingness to use PEP were observed among groups with different ages, educational backgrounds, and levels of knowledge about PEP (all P<0.05). The multivariate logistic regression analysis indicated that educational backgrounds and the levels of knowledge about PrEP/PEP were significant independent influencing factors for the willingness to use these prophylactic measures. (1) Regarding the willingness to use PrEP, compared with those with educational background of junior high school or below, respondents with educational backgrounds of senior high school/vocational high school (OR=5.044), junior college (OR=5.544), and undergraduate (OR=9.579) showed a higher willingness to use PrEP (all P<0.05). Additionally, respondents who had some understanding (OR=3.367) or a good understanding (OR=4.335) of PrEP knowledge also had a stronger willingness to use PrEP (all P<0.05). (2) In terms of the willingness to use PEP, respondents with educational backgrounds of undergraduate (OR=3.413), postgraduate or higher (OR=14.986), as well as those with a good understanding of PEP knowledge (OR=4.754), demonstrated a higher willingness to use PEP (all P<0.05). The multiple response analysis revealed that the internet was the primary channel for this population to acquire PrEP/PEP knowledge (response percentage: 29.50%, case percentage: 88.00%); "Providing subsidies to people who use PrEP/PEP drugs" was the most preferred promotion policy/strategy among the population (response percentage: 20.80%, case percentage: 69.67%). Conclusion A high proportion of the MSM population in Guangxi is willing to use HIV PrEP and PEP drugs, and their willingness is mainly affected by their educational backgrounds and the levels of knowledge about PrEP/PEP. It is suggested that differentiated health education should be implemented in subsequent promotion efforts. Moreover, comprehensive strategies such as online promotion, drug subsidies, and privacy protection should be prioritized to improve the accessibility and utilization rate of these prophylactic drugs.

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