Emotion and empiricism.

Abstract

<h3>Introduction</h3> U.S. HIV/AIDS Strategy has prioritized men who have sex with men (MSM) and people in the Southern U.S. as key populations for HIV prevention interventions. We—a community-academic partnership—conducted formative research on the PrEP care continuum with Black same-gender-loving men (BSGLM) in a Southern U.S. city. <h3>Methods</h3> We conducted six focus group discussions (FGDs) with 35 BSGLM; most had never used PrEP. We explored PrEP awareness and acceptability—the continuum’s first stage. We also conducted 18 in-depth interviews (IDIs) with BSGLM who have taken or discussed PrEP with a provider. The IDIs focused on PrEP uptake—the continuum’s second stage—and adherence and retention in care—the final stage. All FGDs/IDIs were recorded, transcribed, and analyzed using applied thematic analysis. <h3>Results</h3> FGD—participants said BSGLM are generally aware of PrEP, but misinformation exists and knowledge of PrEP-related services is limited. Perceived risk influences PrEP interest—participants explained that BSGLM consider their receptive or insertive role when evaluating HIV vulnerability and BSGLM who do not identify as gay are less interested in PrEP. Fears are also common, including fear of facing consequences of past risky behaviors, others learning of one’s PrEP use, and talking to providers about sexual behaviors. Participants also described existing discrimination and stigma toward BSGLM from multiple sources, including the Black community and the broader MSM community, and concerns about PrEP-related stigma. IDI—participants said PrEP provides a ‘peace of mind’ but acknowledged challenges with pill taking. Several also described experiencing PrEP-related stigma as well as stigma from the Black community for being a Black gay man. <h3>Conclusion</h3> We need multi-level interventions that support BSGLM at each stage of the PrEP care continuum. BSGLM need information to make informed decisions about PrEP and supportive community environments to use PrEP for as long as risk persists.