Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium.
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
J Community Health. 2024 Feb;49(1):156-165. doi: 10.1007/s10900-023-01269-7. Epub 2023 Aug 14.
In Belgium, migrants from Sub-Saharan Africa (SSA) accounted for 45% of new heterosexual HIV infections in 2021, while only 1.5% of PrEP starters were of SSA descent. We explored the acceptance of PrEP and barriers towards PrEP uptake and use among SSA migrant and diaspora communities in Belgium using a participatory action research approach. Trained community researchers (CRs), involved in all phases of the study, co-designed and moderated group discussions (GDs) while simultaneously providing information on HIV and PrEP during workshops. Extensive summaries and field notes were analysed using reflexive thematic analysis. CRs were involved in data analysis, interpretation and reporting. We conducted seven GDs with 51 participants. We identified five major themes: (1) Participants had limited PrEP knowledge, which created feelings of surprise and annoyance about not being informed. This was partly explained by (2) the taboo and stigma that surrounds sexuality and HIV, which could shape PrEP acceptance. (3) Participants shared feelings of otherness due to experiences of racism and discrimination, also in relationship to HIV prevention. (4) PrEP was considered a high-threshold prevention tool, because of its perceived side-effects and its specialized service delivery. (5) Despite nuanced opinions about PrEP, all participants agreed that PrEP promotion should be mainstreamed, so everyone can make an informed decision. In conclusion, PrEP seemed acceptable among our participants. Our qualitative study provides insights into the intersecting barriers to accessing HIV services, showing that SSA diaspora communities are 'hardly reached' rather than 'hard to reach' by PrEP promotion messages.
在比利时，2021 年，来自撒哈拉以南非洲（SSA）的移民占新发生的异性恋 HIV 感染的 45%，而接受 PrEP 的人中只有 1.5%是 SSA 后裔。我们采用参与式行动研究方法，探索了比利时 SSA 移民和侨民社区对 PrEP 的接受程度以及接受和使用 PrEP 的障碍。经过培训的社区研究人员（CRs）参与了研究的所有阶段，共同设计和主持小组讨论（GDs），同时在研讨会期间提供有关 HIV 和 PrEP 的信息。通过反思性主题分析对广泛的总结和实地笔记进行了分析。CRs 参与了数据分析、解释和报告。我们进行了七次 GDs，共有 51 名参与者。我们确定了五个主要主题：（1）参与者对 PrEP 知之甚少，这让他们对没有被告知感到惊讶和恼怒。这在一定程度上可以用（2）围绕性和 HIV 的禁忌和耻辱来解释，这可能会影响 PrEP 的接受程度。（3）参与者由于经历种族主义和歧视而感到与众不同，这也与 HIV 预防有关。（4）PrEP 被认为是一种高门槛的预防工具，因为它被认为有副作用，而且它的服务提供也很专业。（5）尽管对 PrEP 的看法存在细微差别，但所有参与者都同意应该将 PrEP 推广作为主流，以便每个人都可以做出知情的决定。总之，我们的参与者对 PrEP 似乎是可以接受的。我们的定性研究深入了解了获得 HIV 服务的交叉障碍，表明 SSA 侨民社区很难通过 PrEP 推广信息来“接触”到，而不是“难以接触”到。
