title: Complex and Conflicting Social Norms: Implications for Implementation of Future HIV Pre-Exposure Prophylaxis (PrEP) Interventions in Vancouver, Canada.
abstract: BACKGROUND
  HIV Pre-Exposure Prophylaxis (PrEP) has been found to be efficacious in preventing HIV acquisition among seronegative individuals in a variety of risk groups, including men who have sex with men and people who inject drugs. To date, however, it remains unclear how socio-cultural norms (e.g., attitudes towards HIV; social understandings regarding HIV risk practices) may influence the scalability of future PrEP interventions. The objective of this study is to assess how socio-cultural norms may influence the implementation and scalability of future HIV PrEP interventions in Vancouver, Canada.
  
  
  METHODS
  We conducted 50 interviews with young men (ages 18-24) with a variety of HIV risk behavioural profiles (e.g., young men who inject drugs; MSM). Interviews focused on participants' experiences and perceptions with various HIV interventions and policies, including PrEP.
  
  
  RESULTS
  While awareness of PrEP was generally low, perceptions about the potential personal and public health gains associated with PrEP were interconnected with expressions of complex and sometimes conflicting social norms. Some accounts characterized PrEP as a convenient form of reliable protection against HIV, likening it to the female birth control pill. Other accounts cast PrEP as a means to facilitate 'socially unacceptable' behaviour (e.g., promiscuity). Stigmatizing rhetoric was used to position PrEP as a tool that could promote some groups' proclivities to take 'risks'.
  
  
  CONCLUSIONS
  Stigma regarding 'risky' behaviour and PrEP should not be underestimated as a serious implementation challenge. Pre-implementation strategies that concomitantly aim to improve knowledge about PrEP, while addressing associated social prejudices, may be key to effective implementation and scale-up.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Rod
authors.initials: R
authors.lastname: Knight
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.|British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Will
authors.initials: W
authors.lastname: Small
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Carson
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Shoveller
mesh_terms: D002170:Canada; D003710:Demography; D015658:HIV Infections / Q000517:prevention & control*; D006287:Health Planning Guidelines; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D066262:Social Norms; D055815:Young Adult