Enhancing PrEP uptake among MSM: Findings from interviews with researchers and practitioners

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is a prescription antiretroviral medication that an HIV-negative person who is at high risk for HIV infection takes once per day to prevent infection. The most recent National HIV/AIDS Strategy identifies increasing PrEP uptake among men who have sex with men (MSM) as a pillar of ending the AIDS epidemic. Extant literature suggests that barriers to PrEP uptake among MSM are related to access, stigma, and knowledge/attitudes. METHODS: From February-March 2016, semi-structured interviews were conducted with researchers and practitioners in the HIV prevention field who work with MSM in Pittsburgh, Pennsylvania (n=11). An interview guide was used that asked about PrEP barriers and ways to mitigate these barriers. Interview recordings were transcribed and analyzed for key themes using ATLAS.ti software. RESULTS: The original list of 39 codes was condensed into five key themes. The five key themes are that PrEP is empowering; PrEP barriers are multidimensional and overlapping; episodic PrEP is viewed favorably; PrEP needs, access, and perceptions differ by race and age; and risk compensation is real, but it should not be used to prohibit PrEP uptake. A list of all PrEP barriers identified in the interviews is presented. PUBLIC HEALTH SIGNIFICANCE: For public health practice, participants in these interviews identified stigma as more significant of a barrier to PrEP uptake for MSM than its discussion in the existing literature would suggest. PrEP enhancement efforts should simultaneously target multiple barriers across constructs for maximum effectiveness, avoid shaming overtones, and be inclusive of black MSM. A table is presented that may serve as a map to intervention design. Research is needed to test the association of PrEP use and STI incidence in US-based samples, to fine-tune local PrEP uptake efforts in other regions, and to monitor unintended consequences of PrEP uptake in the near or distant future