Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men

Abstract

Combination prevention efforts are now recommended toward reducing HIV incidence among men who have sex with men (MSM). Understanding the perceptions of both MSM and service providers is critical to informing the development of prevention packages and ultimately improving intervention effectiveness. This study assessed the preferences of MSM and health service providers in the administration of HIV-prevention efforts. Qualitative data were gathered from a series of separate MSM and health care provider focus groups in 2 South African cities. Participants discussed HIV-prevention services and MSM client experiences within South Africa and identified the 3 most important clinic characteristics and 3 most important HIVprevention services for MSM clients. Priorities indicated by both MSM and health care providers were confidentiality of visit, friendly staff, and condoms, while discrepancies existed between MSM and providers regarding provider consistency and the provision of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) and lubricant as prevention methods. Effective interventions must address these discrepancies through the design of intervention and provider training to optimally accommodate MSM.

Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

“…The service delivery environment also played a key role in successful PrEP implementation. This was a particularly pressing issue for key populations who already commonly face stigma attending health clinics . Fear of rebuke from providers for not adhering to the medication, or being dropped from a study as a result, was cited as reason for lying about adherence , and points to the need to ensure constructive, open engagement between providers and clients.…”

The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub‐Saharan Africa (HPTN 075)

“…Research is needed to improve understanding of the risks and resiliencies of this key population with respect to HIV transmission, and to develop evidence‐based approaches to meet their urgent HIV prevention needs. MSM and TGW in SSA have previously indicated interest in HIV prevention strategies, including condom use and PrEP [36,37]. The results of HPTN 075 support the conduct of future trials to advance integrated behavioural and biomedical HIV prevention in these key populations.…”

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“…Many hyper-endemic settings also have similar economic configurations characterized by widespread inequality and poor employment opportunities [31,60,61]. This contributes to high circular male labour migration to cities, mines, farms, on the road and on water for more lucrative work; women, meanwhile, have relatively limited employment and wage income [5,[62][63][64][65][66][67].…”

“…Peer support has been shown to improve adherence in outpatients starting ART [57], and adolescents [58]. Group-based interventions for youth offer an effective way to implement intervention content while providing social support from peers, given the importance of peer opinion during adolescence and evidence that peer norms [59][60][61] are important in shaping adolescent behavior [62].…”