Abstract
BackgroundIn Benin, men who have sex with men (MSM) do not always use condoms during anal sex. Pre-exposure prophylaxis (PrEP) using Truvada® (tenofovir disoproxil fumarate / emtricitabine) may be a complementary HIV prevention measure for MSM. This study aimed at identifying the potential facilitators and barriers to the use of PrEP.MethodsThis was a cross-sectional study conducted in 2018 among male-born MSM aged 18 years or older who reported being HIV-negative or unaware of their HIV status. The participants were recruited by the RDS technique (respondent driven sampling) in six cities of Benin. Logistic regression analyses, adapted to RDS statistical requirements, were performed to identify the factors associated with PrEP acceptability.ResultsMean age of the 400 MSM recruited was 26.2 ± 5.0 years. PrEP was known by 50.7% of respondents. The intention to use PrEP was expressed by 90% of MSM. If PrEP effectiveness were 90% or more, 87.8% of the respondents thought they would decrease condom use. In multivariate analysis, the facilitators associated with PrEP acceptability were: not having to pay for PrEP (odds ratio (OR) = 2.39, 95% CI: 1.50–4.46) and its accessibility within MSM networks (OR = 9.82, 95% CI: 3.50–27.52). Only one barrier was significant: the concern that taking PrEP be perceived as marker of adopting HIV risky behaviors (OR = 0.11, 95% CI: 0.04–0.30).ConclusionIn Benin, not all MSM know about PrEP. But once well informed, the majority seems willing to use it if made available. The free availability of the drug and its accessibility in the MSM networks are important facilitators. The possibility of decrease in condom use should not be a barrier to the prescription of PrEP if made available.
Highlights
In Benin, men who have sex with men (MSM) do not always use condoms during anal sex
Participants and procedures This study focused on men who identify themselves as MSM
Before carrying on with the rest of the questionnaire, we provided the following information about Preexposure prophylaxis (PrEP) to all participants: “Pre-exposure prophylaxis is an Human Immunodeficiency Viruses (HIV) prevention method that involves that people without HIV infection take a combination of two antiretroviral drugs in a single pill, used to treat HIV, on a daily or on demand basis
Summary
In Benin, men who have sex with men (MSM) do not always use condoms during anal sex. Preexposure prophylaxis (PrEP) using Truvada® (tenofovir disoproxil fumarate / emtricitabine) may be a complementary HIV prevention measure for MSM. As observed in other African countries [7], MSM in Benin are known to be difficult to access because they live in hiding due to the extent of stigma and discrimination against them. They have less access to curative and preventive care services. Only 33% of MSM in Benin report having used condoms all the time with all their partners in the last 6 months [5] In this context of high risk of HIV infection due to the limited means of behavioural prevention, PrEP, integrated to combination prevention programmes, could prove useful in reducing the risk of transmission [8]
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