JMIR Publications

ABSTRACT

Background:

Men who have sex with men (MSM) are a key group for HIV interventions in Malawi considering their high HIV prevalence (17.5% compared to 8.4% among men in the general population). The use of oral pre-exposure prophylaxis (PrEP) presents a new opportunity for MSM to be protected. We present the findings from a qualitative assessment designed to assess awareness of and willingness and barriers to using PrEP among MSM in Malawi

Objective:

The three main objectives of this assessment were (1)To assess knowledge and attitudes on PrEP uptake and adherence among MSM (2) To assess the factors that influence PrEP uptake and adherence among HIV uninfected MSM (3)To identify the preferences related to health service provision that can contribute to uptake and adherence to PrEP among MSM

Methods:

Ahead of the introduction of PrEP in Malawi, a qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in October 2018 in Blantyre, Lilongwe, and rural districts of Mzimba North and Mangochi. With support of members of the population, study participants were purposively recruited from four MSM-friendly drop-in centres where MSM receive a range of health services to ensure representativeness across sites and age. Participants were asked what they had heard about PrEP; their willingness to use PrEP; their barriers to PrEP use; and their preferences for service delivery. The data were analysed using a thematic content analysis framework that was predetermined in line with objectives

Results:

Most participants were aware of PrEP as a new HIV intervention but had limited knowledge and varying concerns related to its use, including side effects, stigma, frequency of the dose, and cost to repeatedly access PrEP. They highlighted the need to avoid stigmatizing PrEP, especially during marketing, as an intervention for only MSM and female sex workers, instead recommending that it be promoted for everyone. They reported willingness to use PrEP if preferences — such as route of administration, less frequent dosing, and availability of adequate information including benefits and side effects of PrEP and the importance of condom use — were addressed. Respondents recommended that PrEP be provided in safe spaces by MSM-friendly health workers and that financial barriers to PrEP be addressed

Conclusions:

Despite having inadequate knowledge about PrEP, study participants were largely willing to access PrEP if available. Programs should include an effective information, education, and communication component around their preferences and provide PrEP in MSM-friendly sites.