Abstract
BackgroundDespite multiple available HIV prevention methods, the HIV epidemic continues to affect South Africa the most. We sought to understand willingness to use actual and hypothetical HIV prevention methods among participants enrolled in a preventative HIV vaccine efficacy trial in Soweto, South Africa.MethodsWe conducted a qualitative study with 38 self-reporting HIV-uninfected and consenting 18–35 year olds participating in the HVTN 702 vaccine efficacy trial in Soweto. Using a semi-structured interview guide, five focus group discussions (FGDs) were held, stratified by age, gender and sexual orientation. The FGDs were composed of: (i) 10 heterosexual women aged 18–24 years; (ii) 9 heterosexual and bisexual women aged 25–35 years; (iii & iv) heterosexual men aged 25–35 years with 7 in both groups; and (v) 5 men aged 18–35 years who have sex with men. FGDs were audio-recorded, transcribed verbatim, translated into English and analysed using thematic analysis.ResultsWe present five main themes: (i) long-lasting methods are preferable; (ii) condoms are well-known but not preferred for use; (iii) administration route of HIV prevention method is a consideration for the user; (iv) ideal HIV prevention methods should blend into the lifestyle of the user; and the perception that (v) visible prevention methods indicate sexual indiscretion.ConclusionsThe participants’ candour about barriers to condom and daily oral pre-exposure prophylaxis (PrEP) use, and expressed preferences for long-lasting, discreet, lifestyle-friendly methods reveal a gap in the biomedical prevention market aiming to reduce sexually acquired HIV in South Africa. Product developers should consider long-acting injectable formulations, such as vaccines, passive antibodies and chemoprophylaxis, for HIV prevention technologies. Future innovations in HIV prevention products may need to address the desire for the method to blend easily into lifestyles, such as food-medication formulations.
Highlights
Despite multiple available Human Immunodeficiency Virus (HIV) prevention methods, the HIV epidemic continues to affect South Africa the most
Theme 3: administration route of HIV prevention method is a consideration for the user All groups stated that rectal administration routes were acceptable for men who have sex with men to receive HIV prevention, but not for heterosexual populations, even though participants stated both populations can engage in anal intercourse
Theme 4: ideal HIV prevention methods should blend into the lifestyle of the user Participants wanted HIV prevention strategies that could fit in with their lifestyles
Summary
Despite multiple available HIV prevention methods, the HIV epidemic continues to affect South Africa the most. Available strategies include: behavioural strategies such as risk reduction counselling and HIV testing [1] which aim to reduce risky behaviours; barrier methods such as male and female condoms which aim to reduce sexual transmission [2]; the surgical method of voluntary medical male circumcision (VMMC) which reduces biological risk of HIV acquisition for men [3]; and antiretroviral drug methods such as the prevention of mother-to-child transmission [4], treatment as prevention which aim to reduce transmission to partners [5], and post-exposure prophylaxis (PEP) [6]. In some regions, voluntary medical male circumcision [13] are popular and accessible prevention strategies The former relies on adherence and, like many sexual behaviour change methods, is challenged by gender power dynamics [14], and the latter is a method that cannot always be controlled by women or men who have sex with men (MSM) who engage in receptive anal sex. Current licensed drug strategies of PEP and oral PrEP rely on daily adherence
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