Understanding PrEP Acceptability Among Priority Populations: Results from a Qualitative Study of Potential Users in Central Uganda

Abstract

Daily oral pre-exposure prophylaxis (PrEP) can safely and effectively prevent HIV acquisition in HIV-negative individuals. However, uptake of PrEP has been suboptimal in sub-Saharan Africa. The goal of this qualitative study was to identify facilitators of and barriers to PrEP acceptability among target users not taking PrEP. Fifty-nine individuals belonging to Ugandan priority populations participated in a single in-depth interview. Participants perceived themselves as being at high risk for HIV acquisition, and expressed interest in PrEP as an HIV prevention strategy. Two forms of stigma emerged as potential barriers to PrEP use: (1) misidentification as living with HIV; and (2) disclosure of membership in a priority population. Acceptability of PrEP was dampened for this sample of potential PrEP users due to anticipated stigmatization. Mitigating stigma should be a key component of effective PrEP delivery to reach UNAIDS goal of ending the AIDS epidemic by 2030.

Assessing acceptability of pre-exposure prophylaxis (PrEP) among participants in an HIV vaccine preparedness study in southwestern Uganda

“…The common reports of stigma hindering uptake of PrEP among our study participants were similar to the findings from other studies [11,31]. For example, research on uptake of PrEP has reported that stigma associated with being labelled as HIV-infected and being suspected of infidelity or promiscuity, was a barrier to uptake of PrEP [11,32,33].…”

“…Our study findings show that individuals at high risk of HIV infection who were enrolled in an HIV vaccine preparedness study in Uganda were interested in taking oral PrEP because they understood that it would protect them against acquisition of HIV, a finding corroborated by other recent work in Uganda [11,23,24]. However, among those who had chosen to start PrEP many did not initiate and/or persist with the drug.…”

“…To build individuals' confidence in their ability to take PrEP [self-efficacy], it is necessary that they get detailed information on how PrEP works, what to expect in terms of side effects, and how to deal with these issues [28][29][30]. The common reports of stigma hindering uptake of PrEP among our study participants were similar to the findings from other studies [11,31]. For example, research on uptake of PrEP has reported that stigma associated with being labelled as HIV-infected and being suspected of infidelity or promiscuity, was a barrier to uptake of PrEP [11,32,33].…”

“…The acceptability and interest in an intervention such as PrEP is key to its success as individuals are more likely to take it up and/or adhere to it if they consider it acceptable and beneficial to them [10,11]. Factors that influence individuals' acceptability of an intervention have been shown to include its appropriateness in addressing the problem, and suitability for an individual's lifestyle, convenience, social acceptability and effectiveness [12].…”

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

“…Despite emerging qualitative literature around PrEP-related stigma and its impacts [14][15][16][17][18][19][20], quantitative assessment of PrEP-related stigma remains sparse. This is particularly true in SSA, where PrEP implementation continues to scale up among diverse populations.…”