Atujuna Millicent, Newman Peter A, Wallace Melissa, Eluhu Megan, Rubincam Clara, Brown Ben, Bekker Linda-Gail
Desmond Tutu HIV Foundation, Health Sciences Faculty, Institute of Infectious Disease, University of Cape Town, Cape Town, South Africa.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2018 Feb 8;13(2):e0191251. doi: 10.1371/journal.pone.0191251. eCollection 2018.
New biomedical prevention technologies (NPTs) may contribute to substantially reducing incident HIV infections globally. We explored acceptability and preferences for NPTs among key and other vulnerable populations in two South African townships.
We conducted six focus groups and 12 in-depth interviews with adolescents, and adult heterosexual men, women, and men who have sex with men (MSM) (n = 48), and eight in-depth interviews with key informant healthcare workers. The interview guide described pre-exposure prophylaxis (PrEP), vaginal rings, rectal microbicides and HIV vaccines, and explored acceptability and product preferences. Focus groups and in-depth interviews (45-80 minutes) were conducted in Xhosa, audiotaped, and transcribed and translated into English. Data were coded and reviewed using framework analysis with NVivo software.
Overall, initial enthusiasm and willingness to use NPTs evolved into concerns about how particular NPTs might affect or require alterations in one's everyday lifestyle and practices. Different product preferences and motivations emerged by population based on similarity to existing practices and contexts of vulnerability. Adult women and female adolescents preferred a vaginal ring and HIV vaccine, motivated by longer duration of protection to mitigate feared repercussions from male partners, including threats to their marriage and safety, and a context of ubiquitous rape. Male adolescents preferred an HIV vaccine, seen as protection in serodiscordant relationships and convenient in obviating the HIV stigma and cost involved in buying condoms. Adult men preferred PrEP, given familiarity with oral medications and mistrust of injections, seen as enabling serodiscordant couples to have a child. MSM preferred a rectal microbicide given familiarity with gel-based lubricants, with concerns about duration of protection in the context of unplanned consensual sex and rape.
Biomedical interventions to prevent HIV transmission, rather than obviating social-structural factors that produce vulnerability, may be limited by these same factors. Implementation of NPTs should engage local communities to understand real-world constraints and strategise to deliver effective, multi-level combination prevention.
新型生物医学预防技术（NPTs）可能有助于在全球大幅减少新发艾滋病毒感染。我们在南非两个城镇的关键人群和其他脆弱人群中探索了对NPTs的可接受性和偏好。
我们对青少年、成年异性恋男性、女性以及男男性行为者（MSM）（n = 48）进行了6次焦点小组讨论和12次深入访谈，并对关键信息提供者医护人员进行了8次深入访谈。访谈指南描述了暴露前预防（PrEP）、阴道环、直肠杀菌剂和艾滋病毒疫苗，并探讨了可接受性和产品偏好。焦点小组讨论和深入访谈（45 - 80分钟）用科萨语进行，录音、转录并翻译成英语。使用NVivo软件通过框架分析对数据进行编码和审查。
总体而言，最初对使用NPTs的热情和意愿演变成了对特定NPTs可能如何影响或要求改变个人日常生活方式和行为的担忧。基于与现有行为和脆弱背景的相似性，不同人群出现了不同的产品偏好和动机。成年女性和青少年女性更喜欢阴道环和艾滋病毒疫苗，其动机是保护时间更长，以减轻来自男性伴侣的可怕影响，包括对她们婚姻和安全的威胁，以及普遍存在强奸的背景。男性青少年更喜欢艾滋病毒疫苗，认为这是在血清学不一致关系中的保护，并且方便避免艾滋病毒污名以及购买避孕套的成本。成年男性更喜欢PrEP，因为熟悉口服药物且不信任注射，认为这能使血清学不一致的夫妇生育孩子。男男性行为者由于熟悉基于凝胶的润滑剂，更喜欢直肠杀菌剂，同时担心在无计划的自愿性行为和强奸背景下的保护持续时间。
预防艾滋病毒传播的生物医学干预措施，而非消除产生脆弱性的社会结构因素，可能会受到这些相同因素限制。NPTs的实施应让当地社区参与，以了解现实世界的限制，并制定战略来提供有效的多层次综合预防措施。
