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Original article
What are the motivations and barriers to pre-exposure prophylaxis (PrEP) use among black men who have sex with men aged 18–45 in London? Results from a qualitative study
  1. T Charles Witzel1,
  2. Will Nutland1,
  3. Adam Bourne2
  1. 1 Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to T Charles Witzel, Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; charles.witzel{at}lshtm.ac.uk

Abstract

Background Black men who have sex with men (BMSM) have higher HIV incidence and prevalence when compared with other men who have sex with men, despite similar risk profiles. New prevention technologies, including pre-exposure prophylaxis (PrEP), may be effective in responding to these inequalities, provided they are appropriately targeted and acceptable to their intended beneficiaries. This study aims to understand the motivations and barriers of BMSM aged 18–45 to PrEP uptake.

Methods Twenty-five BMSM recruited through geolocation social networking apps took part in in-depth interviews between April and August 2016. Intersectionality theory was used as an organising principle. Interviews were transcribed verbatim and analysed using a thematic framework analysis.

Results For BMSM with heterogeneous social groups, discussions about sexual health were challenging because of the intersection of ethnic background, family history and religion. This limited conversations about PrEP to gay male friends who often held stigmatising views of condomless anal intercourse. BMSM reported exclusion from gay male spaces (online and offline) which could serve to restrict exposure to PrEP messages. Stereotypes of BMSM intersected with negative conceptions of PrEP users, limiting acknowledgement of PrEP candidacy. For those who had attempted to or successfully accessed it, PrEP was framed as a strategy to mitigate risk and to guard against further stigma associated with HIV infection.

Discussion BMSM operate within a complex set of circumstances related to the intersection of their sexual, ethnic, cultural and religious identities, which shape PrEP acceptability. Interventions which seek to facilitate uptake in this group must be attentive to these. Health promotion and clinical services could seek to facilitate nuanced discussions about the merits of PrEP for those at frequent risk, perhaps while also providing publicly visible PrEP role models for BMSM and other marginalised groups.

  • risk
  • pre-exposure prophylaxis
  • health status disparities
  • England
  • sexual and gender minorities

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Handling editor Richard Oliver de Visser

  • Contributors Study conceptualisation: TCW, WRN, AB. Data generation: TCW, WRN, AB. Analysis and interpretation: TCW, AB. Drafting: TCW, AB, WRN.

  • Funding This work was supported by the Wellcome Trust (200172/Z/15/Z).

  • Competing interests TCW has provided research methods training for HIV clinicians on an educational programme organised and paid for by Gilead Sciences.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was provided by the observational research ethics committee of the London School of Hygiene and Tropical Medicine (ref: 10569).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data requests considered by lead author.

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