title: Client and provider perspectives on new HIV prevention tools for MSM in the Americas.
abstract: Men who have sex with men (MSM) in the Americas require targeted, combination HIV prevention approaches. We solicited client and provider perspectives on emerging prevention interventions including HIV pre-exposure prophylaxis (PrEP) and HIV self-tests through focus groups and in-depth interviews with 130 MSM and 41 providers across four sites: New York, San Francisco, Lima, and Rio de Janeiro. Among the MSM participants, we identified three prevention typologies: non-condom users, inconsistent condom users, and consistent condom users. Northern and Southern MSM differed in the variety of harm reduction strategies utilized: where U.S. MSM relied on condom use as well as disclosure and seroadaptive behaviors for prevention, condom use without disclosure or serostatus discussions was the norm in South America. Interest in new prevention technologies was shaped by the social context. U.S. MSM preferences differed by typology, such that non-condom users were interested in taking PrEP and using home HIV tests. MSM in Brazil, regardless of typology, were interested in exploring new prevention options. MSM in Peru demonstrated moderate interest but were less comfortable with adopting new strategies. MSM and providers' opinions differed substantially with respect to new prevention options. Across sites, most providers were reticent to engage with new prevention options, though some NGO-based providers were more supportive of exploring new prevention tools. Both clients and providers will need to be engaged in developing integrated prevention strategies for MSM.
authors.affiliation: Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Lippman
authors.affiliation: Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Koester
authors.affiliation: Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America.
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.affiliation: Asociación Civil Impacta Salud y Educación, Lima, Peru.
authors.forename: Javier R
authors.initials: JR
authors.lastname: Lama
authors.affiliation: HIV/AIDS Clinical Research Centre of the FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Nilo
authors.initials: N
authors.lastname: Martinez Fernandes
authors.affiliation: Asociación Civil Impacta Salud y Educación, Lima, Peru.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gonzales
authors.affiliation: HIV/AIDS Clinical Research Centre of the FIOCRUZ, Rio de Janeiro, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America.
authors.forename: Al
authors.initials: A
authors.lastname: Liu
authors.affiliation: Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Buchbinder
authors.affiliation: Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America.
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Koblin
mesh_terms: D001291:Attitude of Health Personnel; D001727:Bisexuality; D017280:Condoms / Q000706:statistics & numerical data; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D009656:North America; D013020:South America
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