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Readiness for Use of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in Malawi: Qualitative Focus Group
Elizabeth Mpunga1, Navindra Persaud2, Christopher Akolo2
1FHI360, Lilongwe, Malawi.
Background:
Men who have sex with men (MSM) are a key group for HIV interventions in Malawi considering their high HIV prevalence (17.5% compared to 8.4% among men in the general population). The use of oral preexposure prophylaxis (PrEP) presents a new opportunity for MSM to be protected. We present the findings from a qualitative assessment designed to assess awareness of and willingness and barriers to using PrEP among MSM in Malawi.
Objective:
The 3 main objectives of this assessment were to determine: (1) awareness of PrEP, (2) factors that influence willingness to use PrEP, and (3) potential barriers to PrEP use and adherence among MSM in order to guide the design and implementation of a PrEP program in Malawi.
Methods:
Ahead of the introduction of PrEP in Malawi, a qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in October 2018 in Blantyre, Lilongwe, and rural districts of Mzimba North and Mangochi. With support of members of the population, study participants were purposively recruited from 4 MSM-friendly drop-in centers where MSM receive a range of health services to ensure representativeness across sites and age. Participants were asked what they had heard about PrEP, their willingness to use PrEP, their barriers to PrEP use, and their preferences for service delivery. The data were analyzed using a thematic content analysis framework that was predetermined in line with objectives.
Results:
A total of 109 MSM were interviewed-13 through IDIs and 96 through FGDs. Most participants were aware of PrEP as a new HIV intervention but had limited knowledge related to its use. However, the majority were willing to use it and were looking forward to having access to it. IDI participants indicated that they will be more willing to take PrEP if the dosing frequency were appropriate and MSM were involved in information giving and distribution of the drug. FGD participants emphasized that places of distribution and characteristics of the service provider are the key factors that will affect use. Knowing the benefits of PrEP emerged as a key theme in both the IDIs and FGDs. Participants highlighted barriers that would hinder them from taking PrEP such as side effects which were cited in IDIs and FGDs. Key factors from FGDs include cost, fear of being outed, drug stockouts, fear of being known as MSMs by wives, and lack of relevant information. FGDs cited stigma from health care workers, forgetfulness, and community associated factors.
Conclusions:
Despite having inadequate knowledge about PrEP, study participants were largely willing to use PrEP if available. Programs should include an effective information, education, and communication component around their preferences and provide PrEP in MSM-friendly sites.
Insights
Men who have sex with men (MSM) in Malawi show high willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention, despite limited knowledge. Addressing barriers like stigma and ensuring accessible, informative programs are crucial for successful PrEP implementation.
Area of Science:
- Public Health
- HIV Prevention
- Sexual Health
Background:
- Men who have sex with men (MSM) in Malawi exhibit a high HIV prevalence (17.5%), significantly higher than the general male population (8.4%).
- Oral pre-exposure prophylaxis (PrEP) offers a new biomedical intervention to protect MSM from HIV infection.
Purpose of the Study:
- To assess awareness of PrEP among MSM in Malawi.
- To identify factors influencing willingness to use PrEP.
- To determine potential barriers to PrEP use and adherence for program design.
Main Methods:
- A qualitative study employing in-depth interviews (IDIs) and focus group discussions (FGDs) with 109 MSM in Malawi.
- Participants were recruited from MSM-friendly drop-in centers across Blantyre, Lilongwe, Mzimba North, and Mangochi.
- Thematic content analysis was used to analyze data based on study objectives.
Main Results:
- Most MSM were aware of PrEP but lacked detailed knowledge of its use; however, a majority expressed willingness to use it.
- Willingness to use PrEP was influenced by appropriate dosing frequency, community involvement in information dissemination, and understanding PrEP benefits.
- Identified barriers included side effects, cost, fear of disclosure, drug stockouts, stigma from healthcare workers, forgetfulness, and community factors.
Conclusions:
- Despite knowledge gaps, MSM in Malawi demonstrate substantial willingness to adopt PrEP.
- Effective information, education, and communication (IEC) strategies tailored to MSM preferences are essential.
- PrEP program implementation should prioritize MSM-friendly service delivery sites and address identified barriers to ensure uptake and adherence.
