JMIR Publications

ABSTRACT

Background:

Oral Pre-Exposure Prophylaxis (PrEP) effectively prevents HIV but remains unevenly accessible across Europe. Long-acting PrEP (LA-PrEP), recently approved in Europe, offers new HIV protection options. However, no qualitative evidence is available to inform people’s perceptions of this novel modality.

Objective:

This study provides the first large-scale qualitative evidence from 20 European countries on how men-who-have-sex-with-men (MSM) and trans* individuals perceive LA-PrEP.

Methods:

We analysed open-ended responses from 3,123 HIV-negative MSM/trans* individuals who completed the PROTECT survey in English. Participants were asked to describe what LA-PrEP means to them using words or short phrases. We used word clouds for initial insights and Structural Topic Modeling (STM) to identify topics and explore variations in the topics’ relevance across socioeconomic status, migration background, oral PrEP use, and affordability, as well as the association of these perceptions to LA-PrEP intention.

Results:

Descriptively, the responses reflect generally positive associations toward LA-PrEP but with some ambivalent and negative perceptions noted by other participants. STM identified five main response topics: safety, empowerment, convenience/reliability, peace of mind, and concerns/uncertainties. The empowerment offered by LA-PrEP was the most prominent topic, representing one-third of the responses, while concerns/uncertainties made up 20%. Variation in the relevance of these topics was found, showing LA-PrEP as more empowering for individuals with privileged backgrounds, and less relevant for PrEP-naïve individuals or those in countries with limited oral PrEP access and affordability. We also found that ambivalent and negative perceptions are significantly associated with a lower intention to use LA-PrEP.

Conclusions:

Our research shows that MSM and trans* individuals in Europe generally have a positive outlook on LA-PrEP, but highlight significant concerns. To support potential future LA-PrEP implementation in Europe and to maximise its impact, tailored communication strategies that fit with the potential end users’ perceptions are essential for supporting informed decision-making.