Atujuna Millicent, Nyamaizi Alinda M, Duby Zoe, Minnis Alexandra, Diaz Miranda, Palanee-Phillips Thesla, Tenza Siyanda, Reddy Krishnaveni, Nkomana Nqaba, Bekker Linda-Gail, Montgomery Elizabeth
Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Women's Global Health Imperative at RTI International, Research Triangle Park, NC.
J Acquir Immune Defic Syndr. 2025 May 1;99(1):55-63. doi: 10.1097/QAI.0000000000003638.
In sub-Saharan Africa, cisgender men-in particular men who have sex with women (MSW) and, to a lesser degree, men who have sex with men (MSM)-are often under-represented in HIV prevention research, despite their own HIV risk and role in transmission cycles. As HIV prevention research on long-acting pre-exposure prophylaxis (LA PrEP) options expands in sub-Saharan Africa, it is essential to engage these populations to ensure their acceptability. We investigated perceptions of implants and intramuscular injectables as LA PrEP delivery among MSW and MSM.
In-depth interviews were conducted between October 2020 and March 2021 with 40 MSW (n = 20) and MSM (n = 20), aged 18-35 years, self-reported as HIV negative, sexually active, and residing in resource-restricted communities in Cape Town and Johannesburg, South Africa. We explored factors influencing LA PrEP attitudes. Data analysis followed a thematic framework approach.
MSW and MSM found LA PrEP administration modes more acceptable than daily oral PrEP because they offered longer lasting protection while reducing frequent clinic visits for refills. MSW voiced hesitancy around the use of "foreign products," fearing infertility and congenital disabilities in their future children. Both subgroups acknowledged the convenience of implants with long-dosing duration, but injections were deemed to be more discrete and familiar. Both groups described implant use as potentially stigmatizing, with a greater chance of causing tissue scarring from insertion and removal procedures.
Evidence relating to men's engagement in HIV prevention and acceptable modalities of HIV prevention is limited. We found that both groups were enthusiastic about LA PrEP, informing the development of our subsequent clinical study to provide further insight into using placebo versions of LA PrEP and future implementation of LA PrEP options.
在撒哈拉以南非洲地区，尽管顺性别男性——尤其是与女性发生性行为的男性（MSW）以及程度较轻的与男性发生性行为的男性（MSM）——自身面临感染艾滋病毒的风险且在传播循环中发挥作用，但他们在艾滋病毒预防研究中的代表性往往不足。随着撒哈拉以南非洲地区对长效暴露前预防（LA PrEP）方案的艾滋病毒预防研究不断扩大，让这些人群参与进来以确保方案的可接受性至关重要。我们调查了MSW和MSM对植入剂和肌肉注射剂作为LA PrEP给药方式的看法。
2020年10月至2021年3月期间，对40名年龄在18 - 35岁之间、自我报告为艾滋病毒阴性、有性行为且居住在南非开普敦和约翰内斯堡资源有限社区的MSW（n = 20）和MSM（n = 20）进行了深入访谈。我们探讨了影响LA PrEP态度的因素。数据分析采用主题框架法。
MSW和MSM发现LA PrEP给药方式比每日口服PrEP更可接受，因为它们能提供更持久的保护，同时减少了频繁去诊所取药的次数。MSW对使用“外国产品”表示犹豫，担心未来孩子会出现不孕和先天性残疾。两个亚组都认可植入剂给药持续时间长的便利性，但认为注射更隐秘且更熟悉。两组都认为使用植入剂可能会带来污名化，并且插入和取出过程导致组织瘢痕形成的可能性更大。
关于男性参与艾滋病毒预防以及可接受的艾滋病毒预防方式的证据有限。我们发现两组对LA PrEP都很感兴趣，这为我们后续的临床研究提供了依据，以便进一步深入了解使用LA PrEP安慰剂版本以及未来LA PrEP方案的实施情况。
