Perceptions of Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Living with HIV in the Context of Reproductive Goals in South Africa: a Qualitative Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Feb 23

PMID 38389039

Authors

Xolani Ntinga

Oluwaseyi O Isehunwa

Lindani I Msimango

Patricia M Smith

Lynn T Matthews

Alastair van Heerden

Affiliations

Soon will be listed here.

Abstract

Background: Pre-exposure Prophylaxis (PrEP) and Treatment as Prevention (TasP) are effective strategies to prevent HIV transmission within serodifferent couples. However, limited usage of PrEP, knowledge and interest has been amongst the barriers for men, alongside testing and treatment adherence. We explored the perceptions of PreP for HIV prevention with Men living with HIV (MWH) who have reproductive goals, to understand awareness and experiences related to PrEP use in the context of HIV prevention with their partners.

Methods: We undertook a qualitative study with 25 MWH aged 18 to 65 between April and September 2021 in South Africa. Potential participants were screened for eligibility and scheduled to participate in telephonic interviews. Interviews were audio recorded, transcribed, translated and thematically analysed.

Results: Themes were organized into opportunities and barriers that men with HIV articulate as important for using PrEP to meet individual, couple, and community reproductive goals. At the individual level, some men were willing to discuss PrEP with their partners to protect their partners and babies from acquiring HIV. Lack of knowledge about PrEP among men was a potential barrier to promoting PrEP among their female partners. At the couple level, PrEP use was seen as a way to strengthen relationships between partners, signifying care, trust, and protection and was seen as a tool to help serodifferent couples meet their reproductive goals safely. At the community level, PrEP was viewed as a tool to promote HIV testing and prevention efforts, especially among men, but participants emphasized the need for more education and awareness.

Conclusion: Despite PrEP implementation in South Africa, awareness of PrEP among men with HIV in rural areas remains low. Engaging MWH to support their partners in accessing PrEP could be an innovative strategy to promote HIV prevention. Additionally, providing men with comprehensive reproductive health information can empower them to make more informed decisions, adopt safer sexual practices, and challenge societal norms and stigmas around HIV.

Citing Articles

PrEP Awareness and Coverage: Results from the 2022 South Africa Antenatal HIV Sentinel Survey.

Shangase N, Kufa T, Cheyip M, Puren A AIDS Behav. 2025; .

PMID: 39939480 DOI: 10.1007/s10461-024-04609-3.

Oral preexposure prophylaxis uptake, adherence, and persistence during periconception periods among women in South Africa.

Matthews L, Jaggernath M, Kriel Y, Smith P, Haberer J, Baeten J AIDS. 2024; 38(9):1342-1354.

PMID: 38752557 PMC: 11211057. DOI: 10.1097/QAD.0000000000003925.

References

Oldenburg C, Barnighausen T, Tanser F, Iwuji C, de Gruttola V, Seage 3rd G . Antiretroviral Therapy to Prevent HIV Acquisition in Serodiscordant Couples in a Hyperendemic Community in Rural South Africa. Clin Infect Dis. 2016; 63(4):548-54. PMC: 4967606. DOI: 10.1093/cid/ciw335. View

van Vliet M, Hendrickson C, Nichols B, Boucher C, Peters R, van de Vijver D . Epidemiological impact and cost-effectiveness of providing long-acting pre-exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study. J Int AIDS Soc. 2019; 22(12):e25427. PMC: 6922023. DOI: 10.1002/jia2.25427. View

Davies N, Matthews L, Crankshaw T, Cooper D, Schwartz S . Supporting HIV prevention and reproductive goals in an HIV-endemic setting: taking safer conception services from policy to practice in South Africa. J Int AIDS Soc. 2017; 20(Suppl 1):21271. PMC: 5577693. DOI: 10.7448/IAS.20.2.21271. View

Sack D, De Schacht C, Paulo P, Graves E, Emilio A, Matino A . Pre-exposure prophylaxis use among HIV serodiscordant couples: a qualitative study in Mozambique. Glob Health Action. 2021; 14(1):1940764. PMC: 8266225. DOI: 10.1080/16549716.2021.1940764. View

Baeten J, Palanee-Phillips T, Brown E, Schwartz K, Soto-Torres L, Govender V . Use of a Vaginal Ring Containing Dapivirine for HIV-1 Prevention in Women. N Engl J Med. 2016; 375(22):2121-2132. PMC: 4993693. DOI: 10.1056/NEJMoa1506110. View

Kambutse I, Igiraneza G, Ogbuagu O . Perceptions of HIV transmission and pre-exposure prophylaxis among health care workers and community members in Rwanda. PLoS One. 2018; 13(11):e0207650. PMC: 6261021. DOI: 10.1371/journal.pone.0207650. View

Davies N, Ashford G, Bekker L, Chandiwana N, Cooper D, Dyer S . Guidelines to support HIV-affected individuals and couples to achieve pregnancy safely: Update 2018. South Afr J HIV Med. 2018; 19(1):915. PMC: 6244351. DOI: 10.4102/sajhivmed.v19i1.915. View

Bergam S, Harrison A, Benghu N, Khumalo S, Tesfay N, Exner T . Women's Perceptions of HIV- and Sexuality-Related Stigma in Relation to PrEP: Qualitative Findings from the Masibambane Study, Durban, South Africa. AIDS Behav. 2022; 26(9):2881-2890. PMC: 9378426. DOI: 10.1007/s10461-022-03632-6. View

Rodger A, Cambiano V, Bruun T, Vernazza P, Collins S, van Lunzen J . Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016; 316(2):171-81. DOI: 10.1001/jama.2016.5148. View

10.

Gutin S, Harper G, Amico K, Bitsang C, Moshashane N, Harries J . 'I'm waiting for that': Interest in the use of PrEP for safer conception in Botswana. Glob Public Health. 2020; 15(8):1200-1211. PMC: 7718976. DOI: 10.1080/17441692.2020.1741663. View

11.

Mathenjwa M, Khidir H, Milford C, Mosery N, Rambally Greener L, Pratt M . Acceptability of an Intervention to Promote Viral Suppression and Serostatus Disclosure for Men Living with HIV in South Africa: Qualitative Findings. AIDS Behav. 2021; 26(1):1-12. PMC: 8786780. DOI: 10.1007/s10461-021-03278-w. View

12.

Cheng C, Quaife M, Eakle R, Cabrera Escobar M, Vickerman P, Terris-Prestholt F . Determinants of heterosexual men's demand for long-acting injectable pre-exposure prophylaxis (PrEP) for HIV in urban South Africa. BMC Public Health. 2019; 19(1):996. PMC: 6657137. DOI: 10.1186/s12889-019-7276-1. View

13.

Dwyer-Lindgren L, Cork M, Sligar A, Steuben K, Wilson K, Provost N . Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017. Nature. 2019; 570(7760):189-193. PMC: 6601349. DOI: 10.1038/s41586-019-1200-9. View

14.

Matthews L, Greener L, Khidir H, Psaros C, Harrison A, Mosery F . "It really proves to us that we are still valuable": Qualitative research to inform a safer conception intervention for men living with HIV in South Africa. PLoS One. 2021; 16(3):e0240990. PMC: 7993862. DOI: 10.1371/journal.pone.0240990. View

15.

Hancuch K, Baeten J, Ngure K, Celum C, Mugo N, Tindimwebwa E . Safer conception among HIV-1 serodiscordant couples in East Africa: understanding knowledge, attitudes, and experiences. AIDS Care. 2018; 30(8):973-981. PMC: 6095140. DOI: 10.1080/09540121.2018.1437251. View

16.

Rhodes S, McCoy T, Tanner A, Stowers J, Bachmann L, Nguyen A . Using Social Media to Increase HIV Testing Among Gay and Bisexual Men, Other Men Who Have Sex With Men, and Transgender Persons: Outcomes From a Randomized Community Trial. Clin Infect Dis. 2016; 62(11):1450-3. PMC: 4872288. DOI: 10.1093/cid/ciw127. View

17.

Khidir H, Psaros C, Greener L, ONeil K, Mathenjwa M, Mosery F . Developing a Safer Conception Intervention for Men Living with HIV in South Africa. AIDS Behav. 2017; 22(6):1725-1735. PMC: 5554741. DOI: 10.1007/s10461-017-1719-4. View

18.

Lewington J, Geddes R, Gabagaya G . Female empowerment to improve sexual and reproductive health outcomes and prevent violence in adolescent girls and young women in Uganda: evidence reviews for policy. Afr Health Sci. 2023; 22(4):413-427. PMC: 10117494. DOI: 10.4314/ahs.v22i4.47. View

19.

Gwokyalya V, Beyeza-Kashesya J, Bwanika J, Matovu J, Mugerwa S, Arinaitwe J . Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda. Reprod Health. 2019; 16(Suppl 1):64. PMC: 6538556. DOI: 10.1186/s12978-019-0717-6. View

20.

Baeten J, Donnell D, Ndase P, Mugo N, Campbell J, Wangisi J . Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012; 367(5):399-410. PMC: 3770474. DOI: 10.1056/NEJMoa1108524. View