‘PrEP should be for men only’: Young heterosexual men’s views on PrEP in rural South Africa

Hannaford, Alisse; Lim, Jamie; Moll, Anthony; Khoza, Bulelani; Shenoi, Sheela

doi:10.1080/17441692.2020.1744680

Cited by 21 publications

(24 citation statements)

References 33 publications

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“…In order to strengthen MSW’s uptake and use of PrEP, risk perception would, however, have to increase and PrEP information and service delivery would have to be provided in a male-friendly manner. While other qualitative PrEP studies have focused on PrEP acceptability [ 23 – 27 , 31 ], views of MSW as part of ethnic or migrant communities [ 29 , 30 ], or sero-discordant couples’ experience with adherence and side-effects [ 32 , 33 ], our study has depicted MSW’s attitudes and experiences of PrEP in terms of individual, social and sexual behavior and men’s use of clinics in a wider population study.…”

Section: Discussionmentioning

confidence: 99%

“…Both describe men's hypothetical views on taking PrEP, as PrEP was not available at the time of research. Additional PrEP studies involving MSW focused on preferences for particular HIV prevention technologies including PrEP [ 26 – 28 ], exploring views and acceptability of PrEP within communities [ 29 , 30 ], among young heterosexual men [ 31 ] and among sero-discordant couples wanting to conceive [ 32 ]. Only one study documented men (and women’s) actual experiences with PrEP as part of a PrEP trial, highlighting side-effects, adherence, clinic visits and stigma as barriers to PrEP uptake and retention [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

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“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

et al. 2020

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Few studies on HIV Pre-Exposure Prophylaxis (PrEP) have focused on men who have sex with women. We present findings from a mixed-methods study in Eswatini, the country with the highest HIV prevalence in the world (27%). Our findings are based on risk assessments, in-depth interviews and focus-group discussions which describe men's motivations for taking up or declining PrEP. Quantitatively, men self-reported starting PrEP because they had multiple or sero-discordant partners or did not know the partner's HIV-status. Men's self-perception of risk was echoed in the qualitative data, which revealed that the hope of facilitated sexual performance or relations, a preference for pills over condoms and the desire to protect themselves and others also played a role for men to initiate PrEP. Trust and mistrust and being able or unable to speak about PrEP with partner(s) were further considerations for initiating or declining PrEP. Once on PrEP, men's sexual behavior varied in terms of number of partners and condom use. Men viewed daily pill-taking as an obstacle to starting PrEP. Side-effects were a major reason for men to discontinue PrEP. Men also worried that taking anti-retroviral drugs daily might leave them mistaken for a person living with HIV, and viewed clinic-based PrEP education and initiation processes as a further obstacle. Given that men comprise only 29% of all PrEP users in Eswatini, barriers to men's uptake of PrEP will need to be addressed, in terms of more malefriendly services as well as trialing community-based PrEP education and service delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

et al. 2020

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“…Men's acceptance of PrEP has primarily been evaluated among men who have sex with men [28]. Men who have sex with women acknowledge that multiple sexual partners are risky but culturally acceptable, and that they would consider PrEP as an acceptable risk‐mitigation strategy, though anticipate barriers with clinic‐based care [18, 19].…”

Section: Resultsmentioning

confidence: 99%

“…The greatest gap in the PrEP cascade is uptake, particularly for young and mobile individuals [14]. Community‐based PrEP delivery has the potential to address this gap but few models exist, particularly in rural areas [3,8,14–19]. Furthermore, little data exist on PrEP use in the context of alcohol consumption.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a community‐based delivery model for HIV pre‐exposure prophylaxis among bar patrons in rural South Africa

Grammatico

Moll²,

Choi

et al. 2021

J Int AIDS Soc.

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IntroductionSouth Africa, home to the world's largest HIV epidemic, has made great strides in improving access to HIV services, but specific groups, particularly young men, remain difficult to engage in the HIV care cascade. Alcohol use disorder, prevalent in South Africa, further complicates engagement. Congregate settings where alcohol is served, known as shebeens, are an ideal place to engage young people for HIV testing, treatment and prevention, including pre‐exposure prophylaxis (PrEP). Here, we characterize the uptake of PrEP in shebeen patrons and explore the effect of alcohol consumption on PrEP uptake by piloting a community‐based delivery model.MethodsIn the rural Kwazulu‐Natal province (KZN) of South Africa, a field team made up of all men offered screenings outside of shebeens at 27 events over 6 months in 2020. Screenings included rapid HIV testing and Alcohol Use Disorder Identification Test (AUDIT). Participants who tested negative for HIV were offered PrEP as once daily oral tenofovir disoproxil fumarate/emtricitabine. Short‐term retention was determined. Logistic regression was performed to identify predictors of PrEP uptake, including unadjusted and adjusted odds ratios (OR) with 95% confidence interval.ResultsOne hundred and sixty‐two shebeen patrons were screened, and 136 (84%) were eligible for PrEP. Among those eligible, 37 (27%) completed clinical evaluation and initiated PrEP. Among PrEP initiators, 91.9% were men, median age was 26.0 years (interquartile range 21–31), 32.4% were employed, 18.9% had running water and 70.3% had AUDIT scores indicating hazardous drinking. Among 37 initiators, 25 (68%) were retained at 1 month, and 19 (51%) were retained at 4 months. Independent predictors of PrEP uptake among all bar patrons, and only men (108 screened and 34 initiators), included younger age (OR 0.92 [0.88–0.97]) and lifetime number of sexual partners (OR 1.07 [1.02–1.13]).ConclusionsCommunity‐based PrEP delivery after engagement at shebeens in rural South Africa is a feasible and novel approach to reach a traditionally difficult‐to‐engage population, particularly young men. In this small sample, sexual risk behaviours predicted PrEP uptake. Hazardous drinking was not a barrier to PrEP initiation.

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“…In the modelling of Charles's opportunity set, I rely on studies indicating that PrEP likely would be acceptable among young men. For instance, based on their interviews with young heterosexual men in KwaZulu-Natal, Hannaford et al (2020) find that gender norms do not hinder men's taking PrEP. They argue that the gender norms could ‘facilitate PrEP use as men recognise their risk concurrent with their ongoing high-risk behaviours but may also serve as a barrier to the rollout of PrEP among women.’…”

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confidence: 99%

Responsibility for reality: Social norms and the value of constrained choice

Kugelberg

2021

Politics, Philosophy & Economics

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How do social norms influence our choices? And does the presence of biased norms affect what we owe to each other? Looking at empirical research relating to PrEP rollout in HIV prevention policy, a case in which harmful gender norms have been found to impair the choices of young women, I argue that the extent to which we can be held responsible for our choices is connected to the social norms that apply to us. By refining T. M. Scanlon's Value of Choice view, I introduce a norms-sensitive contractualist theory of substantive responsibility. This feminist ‘Value of Constrained Choice view’ presents those who choose under harmful norms as having generic reasons to reject principles that provide them with opportunities they are effectively constrained from choosing. I argue that to fulfil their duties to us, and our duties to each other, policymakers must study the influence of social norms on choice and accommodate it in public policy. Contractualists have reason to pay special attention to social norms, as their unequal effects on choice reveal that we are not living under terms that no one could reasonably reject.

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‘PrEP should be for men only’: Young heterosexual men’s views on PrEP in rural South Africa

Cited by 21 publications

References 33 publications

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

“It’s hard for us men to go to the clinic. We naturally have a fear of hospitals.” Men’s risk perceptions, experiences and program preferences for PrEP: A mixed methods study in Eswatini

Feasibility of a community‐based delivery model for HIV pre‐exposure prophylaxis among bar patrons in rural South Africa

Responsibility for reality: Social norms and the value of constrained choice

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