What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo City Municipality, South Africa

Abstract

Background Compared to women, South African men are less likely to know their HIV status (78% vs 89%), have suppressed viral loads (82% vs 90%), or access HIV prevention services. To achieve epidemic control where heterosexual sexual behavior drives transmission, interventions to improve the uptake of HIV testing services (HTS) and prevention services must also target cis-gendered, heterosexual men. There is limited understanding of these men’s needs and wants with regards to accessing pre-exposure prophylaxis (PrEP). Methods Adult men (≥ 18 years) from a peri-urban community in Buffalo City Municipality were offered community-based HTS. Those who received a negative HIV test result were offered community-based, same-day oral PrEP initiation. Men initiating PrEP were invited to participate in a study exploring men’s HIV prevention needs and reasons for initiating PrEP. An in-depth interview guide, developed using the Network-Individual-Resources model (NIRM), explored men’s perceived HIV acquisition risk, prevention needs, and preferences for PrEP initiation. Interviews were conducted by a trained interviewer in isiXhosa or English, audio-recorded and transcribed. Thematic analysis was used, guided by the NIRM to generate findings. Results Twenty-two men (age range 18–57 years) initiated PrEP and consented to study participation. Men reported elevated HIV acquisition risk associated with alcohol use and condom-less sex with multiple partners as facilitators driving PrEP initiation. They anticipated social support from family members, their main sexual partner and close friends for their PrEP use, and discussed other men as important sources of support for PrEP initiation. Nearly all men expressed positive views of people using PrEP. Participants believed HIV testing would be a barrier for men interested in accessing PrEP. Men recommended that access to PrEP be convenient, rapid, and community-based (i.e., not clinic-based). Discussion Self-perceived risk for HIV acquisition was a major facilitator for men’s PrEP initiation. Although men expressed positive perceptions of PrEP users, they noted that HIV testing may be a barrier to PrEP initiation. Finally, men recommended convenient access points to facilitate PrEP initiation and sustained use. Gender-responsive interventions tailored to men’s needs, wants, and voices will facilitate their uptake of HIV prevention services, and help to end the HIV epidemic.

Experiences of oral pre‐exposure prophylaxis use among heterosexual men accessing sexual and reproductive health services in South Africa: a qualitative study

“…Previous studies have found that negative provider attitudes, lack of privacy, long waiting times and HIV testing are substantial barriers to PrEP uptake and use [12, 22]. In our study, we found several health system factors which supported PrEP use and uptake.…”

“…However, we did not explore the potential impact of alcohol consumption on consistent PrEP use and retention in PrEP care, an area that may be explored in future studies. Previous studies have found that negative provider attitudes, lack of privacy, long waiting times and HIV testing are substantial barriers to PrEP uptake and use [12,22]. In our study, we found several health system factors which supported PrEP use and uptake.…”

“…In this study, PrEP was seen as a preferred HIV prevention method compared to consistent condom use, which was perceived to make sex less pleasurable and was challenging when sex occurred under the influence of alcohol; PrEP counselling should highlight the importance of condom use in addition to PrEP use to enhance protection against HIV and other sexually transmitted infections. Consistent with the literature, alcohol consumption motivated PrEP uptake in our study [12, 22]. However, we did not explore the potential impact of alcohol consumption on consistent PrEP use and retention in PrEP care, an area that may be explored in future studies.…”

“…Although the South African Department of Health (DoH) has recommended oral PrEP to anyone requiring HIV prevention, PrEP programmes have prioritized key populations, including men who have sex with men, sex workers, and adolescent girls and young women (AGYW) [11]. There is limited literature on heterosexual men's experiences of oral PrEP uptake and use in South Africa [12,13]. Heterosexual men's experiences and motivators to PrEP uptake and use may be different to women [14].…”

Pre-exposure prophylaxis for HIV: clinical and social profile of users assisted in specialized service in Alagoas

“…Adicionalmente, um estudo realizado na África do Sul (Smith et al, 2023), sugeriu que homens cisgênero heterossexuais possuem uma menor adesão à PrEP devido a vários fatores sociais, os quais são destaque: o desconhecimento de que a profilaxia é para toda a população que tenha interesse em se proteger ou que tenha comportamentos de risco -incluindo para homens heterossexuais; o medo de fazer a testagem para HIV, a qual é um pré-requisito para dar início ao tratamento; e, por fim, o acesso a serviços de saúde convencionais para realização deste tipo de prevenção. Além disso, notou-se que o grupo de homens heterossexuais não demonstrou estigma em relação ao uso da PrEP, nem em relação aos usuários da profilaxia, reagindo positivamente aos que fazem uso, pois estes pacientes possuem uma maior responsabilidade com a própria saúde.…”