Olugo Phoebe, Nishimura Holly, Thorp Marguerite, Lewis-Kulzer Jayne, Ayieko Bernard, Agot Kawango, Kwena Zachary A, Camlin Carol S, Gutin Sarah A
Impact Research and Development Organization, Kisumu, Kenya.
Division of Prevention Sciences, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
AIDS Care. 2025 May;37(5):728-737. doi: 10.1080/09540121.2025.2480149. Epub 2025 Mar 25.
Daily oral HIV pre-exposure prophylaxis (PrEP) is highly effective when taken consistently, but its uptake remains low among mobile fishermen in Kenya. This study explored barriers and facilitators to PrEP uptake in three Lake Victoria beach communities. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with 65 fishermen, purposively sampled by community, age and study arm. IDIs and FGDs examined PrEP knowledge, perceptions and experiences and were conducted in Swahili or Dholuo, transcribed and translated into English. Data were analyzed using a framework approach. Most participants were >35 years old (56%), married (83%) and half (48%) had completed primary education or higher. Although most had heard of PrEP, some confused it with post-exposure prophylaxis, and many were unsure of correct dosing and eligibility. Barriers to uptake included anticipated partner conflict, confusion with HIV treatment medications and stigma associated with PrEP use, leading to fear of disclosing use to sexual partners. Facilitators included a preference for PrEP over condoms and its perceived protection in sero-different partnerships. Despite free availability in clinics, misconceptions may hinder uptake. Educational interventions are needed to improve PrEP knowledge and reduce stigma, especially among mobile populations like fishermen.
每日口服艾滋病病毒暴露前预防药物（PrEP）如果持续服用效果显著，但在肯尼亚流动渔民中的使用率仍然很低。本研究探讨了维多利亚湖沿岸三个社区中PrEP使用的障碍和促进因素。对65名渔民进行了深入访谈（IDI）和焦点小组讨论（FGD），根据社区、年龄和研究分组进行了有目的的抽样。IDI和FGD调查了PrEP的知识、认知和体验，以斯瓦希里语或多洛语进行，记录并翻译成英语。采用框架方法对数据进行分析。大多数参与者年龄超过35岁（56%），已婚（83%），一半（48%）完成了小学及以上教育。虽然大多数人听说过PrEP，但有些人将其与暴露后预防混淆，许多人不确定正确的剂量和适用情况。使用的障碍包括预期的伴侣冲突、与艾滋病毒治疗药物的混淆以及与使用PrEP相关的耻辱感，导致担心向性伴侣透露使用情况。促进因素包括相对于避孕套更喜欢PrEP及其在血清学不同伴侣关系中被认为的保护作用。尽管诊所免费提供，但误解可能会阻碍使用。需要开展教育干预措施来提高对PrEP的认识并减少耻辱感，尤其是在渔民等流动人群中。
