Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria

Abstract

Background: Men who have sex with men (MSM), female sex workers (FSW) have critical needs for effective HIV prevention tools. This study identified perspectives of MSM, FSW and policy makers on the needs for, barriers to, and challenges with pre-exposure HIV prophylaxis (PrEP); and the logistics required to support roll-out of PrEP for MSM and FSW in Nigeria. Methods: Qualitative and quantitative data were collected through a cross-sectional study. The quantitative data were collected through an online survey administered to 519 MSM, FSW and transgender respondents. The qualitative data were collected through 22 focus group discussions with 140 MSM and 80 FSW, and a two-day consultative workshop with 65 participants. Two open-ended questions in the online survey were also a source of qualitative data. Results of the quantitative data were reported descriptively; the qualitative data were inductively examined with a content analytic approach to construct descriptive categories. The findings from the quantitative and qualitative responses were triangulated. Results: Four hundred and ninety-four (95.2%) online respondents had heard about PrEP through community dialogue (71.3%), and 439 (84.6%) supported its use by MSM and FSW. Fewer than half of the respondents were aware of the clinical care required for PrEP, and misconceptions about PrEP were common. Stated barriers to PrEP uptake were stigma, cost, frequency of HIV counseling and treatment services required, and possible drug-drug interactions. Concerns included possible condom migration, increased risk for sexually transmitted infections and pregnancy for FSW, and poor adherence to medication and hospital schedules. Participants felt that trained peer educators and HIV-test counselors could provide information and refer clients to clinics that provide PrEP. PrEP can be provided through peer-led facilities for MSM and FSW, though its access should be expanded to all persons who are at substantial risk for HIV to prevent negative labeling of PrEP. Public awareness about the use of antiretrovirals for HIV prevention is needed to prevent labeling of PrEP users as being HIV positive. Conclusion: Although MSM and FSW are interested in the use of PrEP, numerous individual and structural barriers need to be addressed to facilitate access to it in Nigeria.

Risk factors for loss to follow‐up among at‐risk HIV negative men who have sex with men participating in a research cohort with access to pre‐exposure prophylaxis in coastal Kenya

“…In this study, we document a higher LTFU rate than previously reported in the pre‐PrEP period (33.7 vs. 23.9 per 100 PY) [11]. While PrEP interest [2,17‐19], and uptake [16] among MSM in SSA is high, PrEP concentrations among 34 MSM and 8 TGW assessed six months following PrEP initiation was low [20], suggesting that MSM face challenges in sustained daily PrEP taking. Therefore, alternative strategies are needed to support daily PrEP taking and to retain participants in prevention services [21].…”

Acceptability of pre-exposure prophylaxis for HIV prevention: facilitators, barriers and impact on sexual risk behaviors among men who have sex with men in Benin

“…In Kenya, it was found that 64.3% of participants had heard of PrEP and only half were willing to use it [ 17 ]. Several barriers were described by authors, such as stigma, cost, frequency of HIV counselling and treatment and possible drug interactions; concerns included the possible abandonment of condoms, increased risk of sexually transmitted infections, and non-compliance with medications and schedules, which need to be taken into account when setting up a PrEP programme [ 18 ].…”

Characterizing low effort responding among young African adults recruited via Facebook advertising

“…There is an increasing need to better understand how Facebook's advertising platform could be used to recruit participants based in African countries. A bulk of web-based studies in African countries have recruited participants mostly through snowball samples of university students [18][19][20][21] and men who have sex with men [22]. In some cases, the recruitment group was comprised of medical practitioners such as physicians [23,24] and public health officials [25].…”