Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Espace Confiance, Abidjan, Côte d'Ivoire.
Front Public Health. 2023 Apr 25;11:1165327. doi: 10.3389/fpubh.2023.1165327. eCollection 2023.
West African men who have sex with men (MSM) remain at substantial risk of contracting HIV. Pre-exposure prophylaxis (PrEP) can be an effective game-changer in reducing the number of HIV infections in MSM communities. To optimize the roll-out of PrEP, we need to better understand how we can increase its uptake. The objective of this study was to explore the perceptions of West African MSM toward PrEP and their proposed strategies to overcome barriers to PrEP uptake within their communities.
Between April 2019 and November 2021, we conducted 12 focus group discussions with 97 MSM not taking PrEP, and 64 semi-structured interviews with MSM taking PrEP, in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Data collection and analysis were guided and conducted by local research teams, enabling a community-based participatory approach. A coordinating researcher collaborated with these local teams to analyze the data guided by a grounded theory approach.
The results show that participants were generally positive toward PrEP and that MSM communities have become more aware of PrEP for the study. We identified three main strategies for increasing PrEP uptake. First, participants proposed to raise awareness and improve knowledge of HIV as they considered the self-perceived risk of MSM in their communities to be low. Second, because of existing misconceptions and false information, participants proposed to improve the dissemination of PrEP to allow for informed choices, e.g., via peers or PrEP users themselves. Third, as oral PrEP also entails a risk of being associated with HIV or homosexuality, strategies to avoid stigmatization (e.g., hiding pills) were deemed important.
These findings indicate that the roll-out of oral PrEP and other future PrEP modalities should be accompanied by raising awareness and improving knowledge on HIV, and wide dissemination of information that focuses on the health-promoting aspect of these tools. Tailored delivery and long-acting PrEP modalities will be important to avoid potential stigmatization. Sustained efforts to prevent discrimination and stigmatization based on HIV status or sexual orientation continue to be highly important strategies to address the HIV epidemic in West Africa.
与男性发生性关系的西非男男性行为者（MSM）仍然面临着感染 HIV 的巨大风险。暴露前预防（PrEP）可以成为减少 MSM 社区中 HIV 感染数量的有效手段。为了优化 PrEP 的推广，我们需要更好地了解如何提高其使用率。本研究的目的是探讨西非 MSM 对 PrEP 的看法，以及他们提出的在社区内克服 PrEP 使用率障碍的策略。
在 2019 年 4 月至 2021 年 11 月期间，我们在布基纳法索、科特迪瓦、马里和多哥进行了 12 次未服用 PrEP 的 MSM 焦点小组讨论，以及 64 次服用 PrEP 的 MSM 半结构式访谈。数据收集和分析由当地研究团队指导和进行，使社区参与式方法成为可能。一名协调研究人员与这些当地团队合作，在扎根理论方法的指导下分析数据。
研究结果表明，参与者普遍对 PrEP 持积极态度，并且 MSM 社区对研究中的 PrEP 有了更多的了解。我们确定了增加 PrEP 使用率的三个主要策略。首先，参与者提出要提高对 HIV 的认识和知识，因为他们认为社区中 MSM 的自我感知风险较低。其次，由于存在误解和错误信息，参与者建议改善 PrEP 的传播，以便进行知情选择，例如通过同伴或 PrEP 用户自己。第三，由于口服 PrEP 也存在与 HIV 或同性恋相关联的风险，因此避免污名化的策略（例如隐藏药丸）被认为很重要。
这些发现表明，口服 PrEP 和其他未来 PrEP 模式的推出应伴随着提高对 HIV 的认识和知识，以及广泛传播侧重于这些工具促进健康方面的信息。定制的交付和长效 PrEP 模式对于避免潜在的污名化将很重要。持续努力防止基于 HIV 状况或性取向的歧视和污名化仍然是应对西非 HIV 流行的重要策略。
