title: Key factors in the acceptability of treatment as prevention (TasP) in Scotland: a qualitative study with communities affected by HIV.
abstract: OBJECTIVE
  There is a clear need to understand the factors that might prevent and/or facilitate the effective use of HIV treatment as prevention (TasP) at an individual level. This paper reports on findings from the first qualitative study in the UK exploring the acceptability of TasP among gay, bisexual and/or men who have sex with men (MSM) and migrant African communities in Scotland.
  
  
  METHODS
  We conducted seven exploratory focus group discussions (FGDs) with convenience samples of MSM (five FGDs, n=22) and mixed-gender African (two FGDs, n=11) participants. Of these, three FGDs were conducted with HIV-positive MSM (n=14) and one FGD with HIV-positive Africans (n=8). We then conducted 34 in-depth interviews (IDIs) with a purposive sample of MSM (n=20) and Africans (n=14, women=10). Half were HIV-positive (MSM, n=10; African, n=7). FGD and IDI data were analysed thematically drawing on predetermined and emergent themes.
  
  
  RESULTS
  We found that inequalities in HIV literacy could be a barrier to TasP, as could social constraints, such as criminalisation of transmission, increased risk of sexually transmitted infection and increased burden of treatment. We also identified psychological barriers such as perceptions of risk. However, relationships and shared decision making were identified as potential facilitators for TasP.
  
  
  CONCLUSIONS
  Our results suggest that potential use and management of TasP may not be straightforward. It could be contingent on reducing inequalities in HIV literacy, minimising the perceived burden of treatment and other potential risks, and addressing the dynamics of existing and socially acceptable risk management strategies, especially in relation to long-term serodiscordant relationships.
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
authors.forename: I
authors.initials: I
authors.lastname: Young
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
authors.forename: P
authors.initials: P
authors.lastname: Flowers
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
authors.forename: L M
authors.initials: LM
authors.lastname: McDaid
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000523:psychology; D044383:Black People; D005006:Ethnicity / Q000523:psychology; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012747:Sexual Partners / Q000523:psychology; D012938:Social Perception; D012959:Socioeconomic Factors; D044465:White People
keywords: GAY MEN; HIV; PROPHYLAXIS; PUBLIC HEALTH; QUALITATIVE RESEARCH