title: "Why should I take drugs for your infection?": outcomes of formative research on the use of HIV pre-exposure prophylaxis in Nigeria.
abstract: BACKGROUND
  Nigeria has the second highest number of new HIV infections annually. Therefore, it is important to explore new strategies for preventing new infections. The introduction of pre-exposure prophylaxis (PrEP) for use by persons at high risk of HIV infection has new potential in preventing new HIV infections. The aim of this study is to explore the public opinion, community interest, and perceptions about the use and access to PrEP in Nigeria.
  
  
  METHODS
  This formative study used a mixed method approach to collect data on public opinions and perceptions on appropriate target groups for PrEP access, community interest, perceptions about the use of PrEP as an HIV-prevention tool, how best to communicate with participants about PrEP, concerns about PrEP use by serodiscordant couples, and suggestions for the design and implementation of a PrEP demonstration project. Telephone and in-depth interviews were conducted, and focus group discussions and consultative meetings were held with critical stakeholders engaged in HIV-prevention, treatment, care, and support programmes in Nigeria. An online survey was also conducted.
  
  
  RESULTS
  HIV serodiscordant couples were identified as the appropriate target group for PrEP use. Most respondents felt that PrEP use by key affected populations would help reduce the HIV incidence. Stigma was identified as a major concern and a potential barrier for the acceptance and use of PrEP by HIV serodiscordant couples. Electronic and print media were identified as important means for massive public education to prevent stigma and create awareness about PrEP. In a male dominated society such as Nigeria, HIV-negative male partners in serodiscordant relationships may resist enrolment in PrEP programmes. This may be complicated by the fact that the identified index partner in most serodiscordant relationships in Nigeria is an HIV-positive woman, who is often diagnosed during pregnancy.
  
  
  CONCLUSIONS
  PrEP uptake and use by HIV serodiscordant couples in Nigeria may face notable but surmountable challenges. Much depends on the appropriateness of actions taken by multiple players. Motivation of HIV-negative male partners to use PrEP and establishment of effective public education programmes in addressing stigma are essential.
authors.affiliation: National Agency for the Control of AIDS, Abuja, Nigeria. jonidoko@yahoo.com.
authors.forename: John
authors.initials: J
authors.lastname: Idoko
authors.affiliation: Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria. toyinukpong@yahoo.co.uk.|New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria. toyinukpong@yahoo.co.uk.|Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria. toyinukpong@yahoo.co.uk.
authors.forename: Morenike Oluwatoyin
authors.initials: MO
authors.lastname: Folayan
authors.affiliation: Department of AIDS Prevention Initiative Nigeria (APIN), Jos University Teaching Hospital, Jos, Nigeria. nancindadem@yahoo.com.
authors.forename: Nancin Yusufu
authors.initials: NY
authors.lastname: Dadem
authors.affiliation: Department of AIDS Prevention Initiative Nigeria (APIN), Jos University Teaching Hospital, Jos, Nigeria. gracehupa@yahoo.com.
authors.forename: Grace Oluwatosin
authors.initials: GO
authors.lastname: Kolawole
authors.affiliation: National Agency for the Control of AIDS, Abuja, Nigeria. anenihj15@yahoo.com.
authors.forename: James
authors.initials: J
authors.lastname: Anenih
authors.affiliation: National Agency for the Control of AIDS, Abuja, Nigeria. eoalhassan@gmail.com.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Alhassan
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D009549:Nigeria; D010465:Perception; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D011639:Public Opinion; D012107:Research Design; D012747:Sexual Partners / Q000523:psychology*; D055815:Young Adult