Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: A qualitative study.

Eliana Miura Zucchi,Alexandre Grangeiro,Leo Pedrana,Laio Magno,Dulce Ferraz,Luís Augusto Vasconcelos Da Silva,Érica Dumont-Pena,Marcia Thereza Couto,Marcelo Castellanos,Thiago Félix Pinheiro,Fernanda Soares De Resende Santos,Inês Dourado,Andrew R Dalby

doi:10.1371/journal.pone.0249293

Abstract

Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW). A qualitative investigation was conducted as part of the formative research of the PrEP15-19 study, an ongoing demonstration study that analyzes the effectiveness of daily PrEP among adolescent MSM, travestis and TGW aged 15-19 in three Brazilian cities. A total of 37 semi-structured interviews and 6 focus groups were conducted. Building from thematic analysis focusing on participants' sexual encounters, perceptions about PrEP efficacy, and vulnerability contexts, we analyzed prospective acceptability of PrEP. Knowledge about PrEP was incipient and characterized by adolescents' frequent doubts about its prescription and efficacy. The 'ideal' use of PrEP appeared together with consistent condom use, especially in casual sex. PrEP use was also mentioned as depending on increased learning about prevention management over time. Main barriers to PrEP use included the incorporation of a daily medication into participants' routine and its impact on their social lives, especially related to stigma. Concerns over short- and long-term side effects were also reported as barriers to PrEP use. TGW and travestis contrasted using PrEP with the precarity of their life conditions, and some expressed a critical vision about PrEP by associating it with pharmaceuticalization and trans necropolitics. Participants' low knowledge and acceptability of PrEP are circumscribed by a rigid perception of condom as the ideal prevention method and the context of their sexual relations. Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care.

Highlights

In many countries including Brazil, adolescent men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection
A qualitative investigation was conducted as part of the formative research of the PrEP1519 study, an ongoing demonstration study that analyzes the effectiveness of daily pre-exposure prophylaxis (PrEP) among adolescent MSM, travestis and TGW aged 15–19 in three Brazilian cities
Prospective acceptability highlights that the successful uptake of PrEP depends on overcoming barriers of access to health services and confronting transphobia and homophobia as part of care

Summary

Introduction

In many countries including Brazil, adolescent men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection. Power structures that legitimate social exclusion and violence against MSM and TGW produce a series of stigmatizing and discriminatory processes that result in critical socio and structural barriers to HIV prevention and care [4,5,6] When such structural processes take plane in health delivery environments, examples of programmatic barriers faced by these populations include limited health clinic hours, discriminatory attitudes by health professionals and flaws in the confidentiality of health services [7,8,9,10]. Adolescents face socio-structural, personal and programmatic barriers to HIV prevention services, highlighting the importance of understanding knowledge and acceptability as essential aspects to promote their broader access to pre-exposure prophylaxis (PrEP). We analyzed the acceptability of PrEP among adolescent men who have sex with men (MSM), travestis and transgender women (TGW)

Objectives

Methods

Results

Conclusion