JMIR Publications

ABSTRACT

Background:

Pre-exposure prophylaxis (PrEP) is a proven effective preventive method in reducing the risk of HIV infection. While daily PrEP is widely used, the on-demand regimen remains less accessible, despite offering advantages such as a reduced pill burden and lower risk of side effects, particularly for those with variable sexual activity patterns.

Objective:

To explore the perceptions of oral PrEP users, who alternated between daily and on-demand regimens, regarding efficacy and safety; motivation for choosing between regimens; suitability for prevention needs and sexual routines; and adherence support through a hypothetical smartphone application.

Methods:

The research was conducted in five Brazilian cities and included 19 individual interviews and five focus groups with 47 participants, all cisgender men who used PrEP on demand. The sample was diverse regarding PrEP use duration, adherence, regimen failure experiences, age range, and education level. Data were analyzed using thematic analysis.

Results:

Participants found oral PrEP to be effective and safe, highlighting the reduction in anxiety and fear of HIV infection. Memories of the AIDS crisis had a positive influence on older participants. In comparison, younger participants saw PrEP as essential for navigating new forms of socialization and sexual interaction mediated by apps such as Grindr. On-demand PrEP was valued for its reduced pill count and lower risk of adverse effects, making it ideal for those with alternating periods of intense sexual activity. However, the discipline required to follow the on-demand regimen stood out as a challenge. The idea of an app to support adherence to on-demand PrEP was widely accepted. Participants suggested features such as reminders to take pills, management of appointments and tests, and location of PEP services. However, concerns about security and privacy were highlighted, especially regarding integration with other apps and access by third parties. The suggestion was for State management of the app to ensure reliability and transparency in data management.

Conclusions:

The literature supports the importance of digital tools in disseminating information about sexual health and HIV prevention. Mobile applications can be valuable additional resources, improving adherence and effective use of PrEP. Future studies should explore the perceptions of daily PrEP users and those who have opted for other combination HIV prevention strategies to map the perceived advantages and disadvantages of different regimens.