Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil

ABSTRACT

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants’ knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants’ opinions about PrEP’s contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil’s civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.

KEYWORDS:

• PrEP
• men who have sex with men
• HIV care continuum
• STD/STI
• Brazil

Acknowledgments

The authors would like to express their gratitude to the participants of the study, to the local team that carried out the fieldwork in Salvador-Lucilia Nascimento, Ailton Jesus da Silva, Filipe Matheus Duarte, Fernanda Encarnação, Munyra Araújo and all collaborating NGO-Gay Group of Bahia (GGB) and Grupo de Apoio à Prevenção à Aids da Bahia (GAPA-Bahia). We are also grateful for the support of Brazilian Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis of the Secretariat for Health Surveillance of the Ministry of Health; and the Brazil Community Health Fellowships Program as part of Brown University’s Brazil Initiative. This manuscript has not been submitted or accepted for publication elsewhere. All authors contributed to the concept of the paper and data analysis. LM, ID, CSC, DW, LS, and AN interpreted the results and were responsible for writing the final version of the manuscript. FS helped with a draft version of the manuscript. LK and PC revised and contributed to the final version of the manuscript. OO and JB were on-site investigators that collected, coded, and analysed the data. All authors have read and approved the paper, meet the criteria for authorship as established by the International Committee of Medical Journal Editors, believe that the paper represents honest work, and are able to verify the validity of the results reported.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Yusuf Ransome http://orcid.org/0000-0003-4170-2001

Additional information

Funding

Financial support for this study was provided by Brazilian Ministry of Health, through its Secretariat for Health Surveillance and its Department of Prevention, Surveillance and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis through grant number LN7901-BR. Additional funding was provided by the National Institute of Mental Health through grant numbers R25MH083620 and T37MD008655. This study received financial support from the Brown University Brazil Initiative. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.