Abstract
Background
Key populations, especially men who have sex with men (MSM), are at a greater and consistent risk of acquiring HIV. Condomless anal sex (CAS) presents the highest risk sex act for HIV transmission among MSM. To curb the rates of HIV transmission among MSM, all potential prevention modalities should be made available and accessible, with tailored demand creation strategies to improve uptake and encourage correct use of HIV prevention methods. Event Driven Pre-Exposure Prophylaxis (ED-PrEP) provides a novel and evidence-based solution to many reported barriers to the uptake of existing HIV prevention methods (daily PrEP, male circumcision, condom use) among MSM. The aim objective of the study was to investigate the knowledge, attitudes, and perceptions (KAP) of MSM towards ED-PrEP across the five districts and explore relationships exist between socio-demographic characteristics, sexual risk profiles, and the willingness of MSM to use ED-PrEP.
Methods
Employing a prospective descriptive cross-sectional survey, this study explored the perceptions, attitudes, and knowledge regarding ED-PrEP among MSM across five distinct South African districts: eThekwini, uMgungundlovu, Ehlanzeni, Ekurhuleni, and the City of Tshwane. The target demographic encompassed MSM frequenting specialized drop-in clinics catering to their needs and offer tailored HIV prevention, testing, and treatment services for MSM. Using a combination of snowball and convenience sampling methods, the research enrolled 295 participants who completed a comprehensive KAP survey via an online platform from April to June 2023. Data analysis utilized SPSS 29.0, enabling a robust examination through descriptive statistics, chi-square analyses, and logistic regression to derive meaningful insights from the collected information.
Results
The descriptive results illustrate a diverse representation across various demographic categories among the surveyed MSM population. The majority of participants fell within the age categories of 18–24 (44.7%) and 25–34 (42.0%), with a smaller proportion aged over 35 (13.2%). Regarding race/ethnicity, a significant percentage identified as Black (94.2%), with smaller representations from Indian (1.4%), Coloured (2.4%), and White (2.0%) ethnicities. In terms of sexual orientation, the largest group engaged in sex with mainly male partners (36.6%) or exclusively male partners (29.5%), while a smaller number reported diverse sexual partners. Education-wise, most individuals had completed high school or held an equivalent diploma (64.4%), followed by university education (11.9%). In terms of income, the majority reported an average monthly income between R0 and R1000 (55.6%), followed by R1001–R2500 (11.2%) and R2501–R5000 (13.9%), with smaller percentages in higher income brackets.
vi
Approximately 71.9% of the participants demonstrated good knowledge of ED-PrEP: 58% of them had a positive attitude towards it. Age, race, sexual orientation, level of education, and district were examined for their influence on knowledge and attitudes, but found no significant associations except for district, where eThekwini and Ekurhuleni demonstrated higher levels of good ED-PrEP knowledge.
Regarding the likelihood of recommending ED-PrEP to others is concerned, the results showed no significant association in terms of participants’ age and race/ethnicity (p>0.05). However, several factors exhibited significant relationships in relation to participants’ likelihood to recommend ED-PrEP to others: namely sexual orientation (p<0,05), perceived risk of acquiring HIV (p<0,001, and education level (p<0,001). Average income per month, education level and district of residence were strong predictors of participants’ likelihood to recommend ED-PrEP to others, with the likelihood ratio at p<0.05 for these variables.
Conclusion
The findings of the study showed than MSM in South Africa display a high level of ED-PrEP awareness and have a significant level of interest in taking ED-PrEP. These findings will inform the implementation of ED-PrEP, the development of communication materials, as well as potential policy changes related to PrEP guidelines.
Thus, the study findings provide valuable insights into the knowledge, attitudes, and perceptions of MSM about the use of ED-PrEP in South Africa. Understanding these factors can inform the implementation of interventions and strategies tailored to improve ED-PrEP uptake and adherence among this key population, thus contributing to efforts to control the HIV epidemic.
This cross-sectional study delved into understanding MSM attitudes, knowledge, and perceptions concerning ED-PrEP in South Africa across diverse districts, aiming to shape policy changes for widespread ED-PrEP introduction. While the study illuminated high ED-PrEP knowledge among MSM, notably in urban areas, significant gaps persist, fostering misconceptions that could hinder its effective adoption. These findings highlight the necessity for meticulous and targeted educational campaigns to dispel myths and present ED-PrEP as a safe, alternative HIV prevention method for all men. The study's evidence offers a pivotal basis for policy changes, emphasizing the need for informed health worker training, enhanced guidelines, user-friendly risk assessment tools, and tailored educational materials for MSM and the broader male population. Recommendations focus on policy amendments, robust healthcare training, accurate self-assessment tools, tailored educational content, targeted awareness campaigns, public health support, and further research avenues. These steps aim to strengthen HIV prevention strategies and promote ED-PrEP across South Africa, propelling comprehensive prevention efforts benefiting all men in the country.