Department of Anthropology and Sociology of Development, Graduate Institute of International and Development Studies, Geneva, Switzerland.
Department of Social and Environmental Health Research, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2018 Aug 23;13(8):e0202830. doi: 10.1371/journal.pone.0202830. eCollection 2018.
Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective, evidence-based option for HIV prevention. In England, issues of cost-effectiveness and of responsibility for commissioning prevention services have so far led National Health Service (NHS) England to decide not to commission PrEP. Given the significant lag between the awareness of PrEP efficacy and the opportunity to obtain PrEP through traditional health care routes, many gay and other men who have sex with men (MSM) have turned to 'DIY PrEP', purchasing generic formulations of PrEP for themselves on the internet or via other alternative routes. However, there is very little research on DIY PrEP practices and no qualitative study with DIY PrEP users in the UK. A formative qualitative study was conducted in 2017 to inform the development of an intervention (PrEP Club) to support DIY PrEP users and improve the safety and experience of this prevention strategy. Focus groups were held with 20 MSM who are based in London and are obtaining PrEP through means other than clinical trials, to explore their accounts of sourcing and using PrEP and the experiential meanings of these. In this article, we report findings from this first, formative study and present the different practices involved in finding out about PrEP, buying it and ascertaining legitimacy of sellers and products. We reflect on the uncertainties participants described related to actually using PrEP, including deciding on drug dosing and monitoring their health. Finally, we present the results of the discussions participants had about the kind of support they had received, the help they would have liked, and their views on proposed interventions to support DIY PrEP users, such as PrEP Club.
暴露前预防（PrEP）用抗逆转录病毒药物是一种有效的、有证据支持的艾滋病预防选择。在英国，成本效益问题以及负责委托预防服务的问题，导致国民保健服务（NHS）英格兰决定不委托 PrEP。鉴于 PrEP 疗效的认知与通过传统医疗途径获得 PrEP 的机会之间存在显著滞后，许多男同性恋者和其他与男性发生性关系的男性（MSM）已经转向“DIY PrEP”，在互联网上或通过其他替代途径为自己购买 PrEP 的通用制剂。然而，关于 DIY PrEP 实践的研究很少，也没有在英国对 DIY PrEP 用户进行定性研究。2017 年进行了一项形成性定性研究，为开发一项干预措施（PrEP Club）提供信息，以支持 DIY PrEP 用户，并提高这种预防策略的安全性和体验。与 20 名居住在伦敦的 MSM 举行了焦点小组会议，他们通过临床试验以外的其他方式获得 PrEP，以探讨他们获取和使用 PrEP 的情况以及这些情况的体验意义。在本文中，我们报告了这项首次形成性研究的结果，并介绍了寻找、购买 PrEP 以及确定卖家和产品合法性所涉及的不同做法。我们反思了参与者描述的与实际使用 PrEP 相关的不确定性，包括确定药物剂量和监测他们的健康。最后，我们介绍了参与者讨论的结果，包括他们已经获得的支持、他们希望得到的帮助，以及他们对支持 DIY PrEP 用户的干预措施（如 PrEP Club）的看法。
