Abstract
BackgroundHeterosexual men in South Africa are a large key population to exposure to HIV, yet preferences for HIV pre-exposure prophylaxis (PrEP) among this population have not, to date, been investigated in the literature. This paper aims to explore HIV prevention preferences among heterosexual men in urban South Africa, as well as to examine the demand and characteristics of men who favour long-acting injectable (LAI) PrEP over condoms and oral PrEP.MethodsData were collected among 178 self-reported HIV-negative heterosexual men, who were given example products and information before being asked which they preferred. Multivariate logistic regression was used to analyse which characteristics were associated with product choice.Results48% (n = 85) of participants preferred LAI PrEP, while 33% (n = 58) and 20% (n = 35) chose oral PrEP and condoms respectively. Having children (marginal effect = 0.22; 95% CI [0.01, 0.44]) or having higher risk attitude scores (marginal effect = 0.03; 95% CI [0.01, 0.06]) was significantly associated with a choice of LAI PrEP, while those who had unprotected anal intercourse (marginal effect = − 0.42; 95% CI [− 0.57, − 0.27]) and those who were concerned with protection against other sexually transmitted infections over HIV (marginal effect = − 0.42; 95% CI [− 0.60, − 0.24]) appeared less likely to prefer LAI PrEP.ConclusionsThe results suggested a relatively high demand and theoretical acceptability for LAI PrEP among heterosexual men in urban South Africa, but there appeared to be fewer distinct predictors for the willingness to use LAI PrEP compared to studies conducted among gay and bisexual men and women. Nevertheless, the findings contribute to the mapping of the demand and determinants of heterosexual men’s preferences for novel antiretroviral-based prevention in sub-Saharan Africa, and the data could aid in the differentiated design of future HIV prevention strategies using LAI PrEP in conjunction with other methods.
Highlights
Heterosexual men in South Africa are a large key population to exposure to human immunodeficiency virus (HIV), yet preferences for HIV pre-exposure prophylaxis (PrEP) among this population have not, to date, been investigated in the literature
Almost half of the participants in this study indicated a preference for long-acting injectable (LAI) PrEP over oral PrEP or condoms, with the effectiveness of the HIV prevention method being the most important product attribute
LAI PrEP has relatively high theoretical acceptability among heterosexual men in urban South Africa, where the effectiveness of products is found to be highly critical to the attractiveness of an HIV prevention product
Summary
Heterosexual men in South Africa are a large key population to exposure to HIV, yet preferences for HIV pre-exposure prophylaxis (PrEP) among this population have not, to date, been investigated in the literature. According to the South African National HIV Survey [5], the main route of transmission is through heterosexual sex, which suggests that alongside the needs of focusing on key populations such as female sex workers and men who have sex with men, the heterosexual population should be a focal point for effective HIV prevention methods. Condoms have been a longstanding and efficacious method to prevent HIV transmission and other sexually transmitted infections (STIs) [6], yet consistent condom usage is low in the general population – only 31.9% of the general population aged over 15 reported using condoms every time or almost every time with their last sexual partner in the South African National HIV Survey in 2012 [5]
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