title: Barriers to uptake and use of pre-exposure prophylaxis (PrEP) among communities most affected by HIV in the UK: findings from a qualitative study in Scotland.
abstract: OBJECTIVE
  To explore the acceptability of pre-exposure prophylaxis (PrEP) among gay, bisexual and men who have sex with men (MSM) and migrant African communities in Scotland, UK.
  
  
  METHODS
  Consecutive mixed qualitative methods consisting of focus groups (FGs) and in-depth interviews (IDIs) explored PrEP acceptability. Data were digitally recorded, transcribed and analysed thematically to identify anticipated and emerging themes.
  
  
  METHODS
  Participants were recruited through community sexual health and outreach support services, and from non-sexual health settings across Scotland.
  
  
  METHODS
  Inclusion criteria included identification as either MSM and/or from migrant African communities; 18 years and older; living in Scotland at the time of participation. 7 FGs were conducted (n=33): 5 with MSM (n=22) and 2 mixed-sex groups with African participants (n=11, women=8), aged 18-75 years. 34 IDIs were conducted with MSM (n=20) and African participants (n=14, women=10), aged 19-60 years. The sample included participants who were HIV-positive and HIV-negative or untested (HIV-positive FG participants, n=22; HIV-positive IDI participants, n=17).
  
  
  RESULTS
  Understandings of PrEP effectiveness and concerns about maintaining regular adherence were identified as barriers to potential PrEP uptake and use. Low perception of HIV risk due to existing risk management strategies meant few participants saw themselves as PrEP candidates. Participants identified risk of other sexually transmitted infections and pregnancy as a concern which PrEP did not address for either themselves or their sexual partners. PrEP emerged as a contentious issue because of the potentially negative implications it had for HIV prevention. Many participants viewed PrEP as problematic because they perceived that others would stop using condoms if PrEP was to become available.
  
  
  CONCLUSIONS
  PrEP implementation needs to identify appropriate communication methods in the context of diverse HIV literacy; address risk-reduction concerns and; demonstrate how PrEP can be part of a safe and comprehensive risk management strategy.
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Young
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Flowers
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: McDaid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015658:HIV Infections / Q000517:prevention & control*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH