“How I Wish This Thing Was Initiated 100 Years Ago!” Willingness to Take Daily Oral Pre-Exposure Prophylaxis among Men Who Have Sex with Men in Kenya

Abstract

BackgroundThe MSM population in Kenya contributes to 15% of HIV incidence. This calls for innovative HIV prevention interventions. Pre-exposure prophylaxis (PrEP) has been efficacious in preventing HIV among MSM in trials. There is limited data on the willingness to take daily oral PrEP in sub-Sahara Africa. PrEP has not been approved for routine use in most countries globally. This study aimed to document the willingness to take PrEP and barriers to uptake and adherence to PrEP in Kenya. The findings will inform the design of a PrEP delivery program as part of the routine HIV combination prevention.MethodsEighty MSM were recruited in 2 Counties in December 2013. Quantitative data on sexual behaviour and willingness to take PrEP were collected using semi-structured interviews and analysed using SPSS. Qualitative data on knowledge of PrEP, motivators and barriers to uptake and adherence to PrEP were collected using in-depth interviews and FGDs and analysed using Nvivo. Analysis of data in willingness to take PrEP was conducted on the HIV negative participants (n = 55).Results83% of MSM were willing to take daily oral HIV PrEP. Willingness to take PrEP was higher among the bi-sexual and younger men. Motivators for taking PrEP were the need to stay HIV negative and to protect their partners. History of poor medication adherence, fear of side effects and HIV stigma were identified as potential barriers to adherence. Participants were willing to buy PrEP at a subsidized price.ConclusionsThere is willingness to take PrEP among MSM in Kenya and there is need to invest in targeted education and messaging on PrEP to enhance adherence, proper use and reduce stigma in the general population and among policy makers.

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

“…Very few studies reported clear opposition to PrEP as an HIV prevention tool, although some generated evidence of community distrust of study/trial designs or of the concept of PrEP itself . Theoretical studies among potential end‐users typically found high acceptability of PrEP . By including the theoretical research, a range of regimens are included in the review including: oral daily and intermittent (the definition of which is particular to the given study), as well as emerging injectable and vaginal ring products.…”

“…The potential to use anti‐retroviral therapy (ART) to prevent HIV infection seemed counter‐intuitive to some potential users where prior experience was focused on treating sick people with ART. When PrEP was described to a naïve potential user, concern was common that taking the same medications used to treat diagnosed HIV will mean “people will just assume I have HIV” . Such findings suggest that HIV related stigma is still so pervasive that it may pose a challenge to PrEP provision whether or not it is linked to services also providing ART to HIV positive people .…”

“…Several studies suggest that PrEP is conflated with ART not just in personal understandings of PrEP but in expectations of how others will respond, generating fear of HIV‐related stigma and discrimination. This potential stigma has been highlighted among MSM in Kenya ; women who inject drugs in Kenya ; female sex workers in Kenya and South Africa ; female partners of migrant workers returning to Mozambique for short periods ; and women at high risk of HIV infection in South Africa . Participants in all these studies broadly welcomed the opportunity to avoid HIV infection but were apprehensive about being seen to take ART.…”

HIV preexposure prophylaxis for adolescents and young adults

“…A systematic review described strong interest and support for PrEP use among many younger populations at risk of HIV infection including adolescent girls and young women, youth who identify as transgender, and, to a lesser extent, youth who inject drugs [26]. Two recent mixed-method studies of MSM, one in Kenya and one in the UK, found that younger men were more willing than older MSM to take daily oral PrEP [27, 28]. A mixed-methods study in South Africa, found that 90% of 16–17 year olds reported that they would want to use PrEP if they had a partner who was HIV-infected or whose HIV status was unknown, or would support PrEP use for their partners [29].…”

What motivates serodiscordant couples to prevent HIV transmission within their relationships: findings from a PrEP implementation study in Kenya

“…In addition, understanding how prevailing gender norms and relationship dynamics influence perceptions of responsibility to prevent HIV is of critical importance, especially given the evidence suggesting that such factors shape HIV risk among both men and women (Higgins, Hoffman, and Dworkin 2010; Leddy et al 2016). While several studies have examined motivations for use of PrEP and ART as HIV prevention among gay male couples (Brooks et al 2015; Gamarel and Golub 2015; Karuga et al 2016), relatively few studies have been published examining these motivations among heterosexual couples in sub-Saharan Africa (Ngure et al 2016). …”