Table 2.
Participants' Statements Regarding the Acceptability and Adoption of PrEP
| Ecological level | Theme | Quote |
|---|---|---|
| Individual | Beliefs about PrEP effectiveness | “I wouldn't take that choice. No, 90% [effective], no. I don't like odds. I like 100 to 0. Cause 100%, then again, but 90 to 10, my luck is very, very bad so I'd be 1 out of the 10. No, I wouldn't take that chance.” (BMSM) |
| Fears of side-effects and giving medication to healthy people | “It depends on the side effects. If I'm going to take something I want to make sure because my own behavior can help me from contracting HIV … I wanna make sure that the side effects ain't going to be worse than death–well it's not death because many people are living with it.” (BMSM) | |
| “Pills over a period of time can become toxic in your system…People just don't like popping pills. I still have a difficult time taking a pill. Because it's like you're putting something in your body, and once you put it in there, you don't have any control anymore.” (BMSM) | ||
| Interpersonal | Risk disinhibition and STI risks | “It's basically just telling people that it's okay for them to go out there and have random sex, unprotected sex with anybody who they want. Why you going to give them something pre [sex], they need something for now, because they don't know who they have slept with and who that person has had or what that person got.” (Community Stakeholder) |
| “I believe it's a good option to have, like I said it kinda just still loses the STI piece of it.” (BMSM) | ||
| “The only thing that's running through people's minds is that Oh my God, I can take a pill, and If I do this right, I'm not gonna catch HIV. They're gonna not be thinking about, Oh, but I could still get Gonorrhea or syphilis or something. They just, the whole thing is I'm not gonna get HIV.” “So you're telling me that those are not important anymore. So I don't think so. Syphilis is still a bad thing.” (BMSM) | ||
| “If you have an untreated STD then your probability of infection just goes sky high so I think the messages of continuing to make sure you're STD free and things of that nature are important and that it's [PrEP] not for everyone.” (Community Stakeholder) | ||
| No single solution | “So I think the messaging needs to be very clear to this group that it's not the end all be all with one pill, that there's still a small chance that if the condom breaks or you don't use condoms that you could become infected. That it's important to take it in collaboration with condoms, continue to promote the importance of condoms and also promote the importance of screenings for STDs and make sure that you're STD free if you're gonna start using PrEP because even if you—you know you use PrEP and the condom breaks, you know, there is the possibility you can get infected.” (Community Stakeholder) | |
| “So I think the messaging needs to be very clear to this group that it's not the end all be all with one pill, that there's still a small chance that if the condom breaks or you don't use condoms that you could become infected. That it's important to take it in collaboration with condoms, continue to promote the importance of condoms and also promote the importance of screenings for STDs and make sure that you're STD free if you're gonna start using PrEP because even if you–you know you use PrEP and the condom breaks, you know, there is the possibility you can get infected.” (Community Stakeholder) | ||
| Community | Medical mistrust | “The government is trying to make money off us because there's money in medicine. The government is trying to get us to just pop a pill and just be done with it or whatever.” (BMSM) |
| “What I would hear from clients is they're not as confident navigating with their medical providers, generally, and also confidential(ity). A lot of them say, ‘Well, who's gonna have access to that information?’ They have a point. They're like, ‘Well, will the government see this?’” (Community Stakeholder) | ||
| “We just ain't gonna believe it ‘cause a lot of us think that's just some shit people are trying to sell to use us as guinea pigs.” (BMSM) | ||
| Who needs PrEP? | “I don't think that people are scared of catching HIV no more because they go out there and they go crazy and have unprotected sex. And then when they catch it now, at first they're worried. And they lay it down. They feel good because they have this reassurance that this pill will take them a long way. So I think this is what now invites them. It ain't a death sentence. I just take some pills. I live a normal life.” (Community Stakeholder) | |
| “Tops are less likely to get it anyway, they can still get it, obviously, but they're less likely to get it than bottoms…I'm sure a lot of other people will have that same mindset.” (BMSM) | ||
| “Getting promiscuous people. Teenagers. They fuck everything like there's no tomorrow. As adults now, we don't just go and fuck anyone…Maybe the condom's not available when you're fucking. Maybe one breaks and you only have one. A lot of things happen.” (BMSM) | ||
| “But since I know how unsexually active I am, it's just something I feel would become tedious after a while or become tedious if I'm just taking it and I'm not doing anything. That might lead me to not take it.” (BMSM) | ||
| Structural | Stigma and PrEP | “If somebody knew I was asking about that pill…then there is a stigma that goes along with that. And I think that people will obviously look at you differently, even black men. If they thought that you was HIV-positive, they usually associate that with being gay, and then they would look at you differently for being gay. That's still in the black community.” (BMSM) |
| “That's predicated on someone actually showing up to the clinic, meaning they've crossed all the barriers of access and perceived homophobia and perceived racism and perceived cost issues or whatever goes into access. And then they've met a provider who they feel comfortable with enough to discuss these things and the provider is knowledgeable and willing to engage that young person in these issues.” (Community Stakeholder) | ||
| Structural barriers to PrEP use | “Like, I just—I—I'm a very—I try to be a very structure person, even though sometimes that leads to my demise ‘cause I always feel like I have to get one thing first, and then it will lead to the next. So my focus is work. Like, I need to find work. Like, I need a job. And then with a job, then I could look into the resources on how to get some type of health coverage. ‘Cause then at that point, I won't feel like I'm just a part of the system. I feel like I just need assistance.” (BMSM) | |
| “I had no money and to be honest with you, around that time I was kind of the breadwinner in the house. Nobody else really—my mother didn't have a job. My grandmother was too old to work and then besides that, she was too busy taking care of my mother's kids to go out and work so I was always the one who would go out and get money and stuff like that, even though I know that my grandmother used to ask me, ‘Where did you get this money from?’ It's like, ‘Where do you get these clothes from?’ and stuff like that. But I'd always lie to her, ‘Oh doing this and doing that.’ I would tell her—I told her one time, because I used to tell her like one time this club, they would pay me to sing. I would tell her like that—stuff like that. I would tell I was waitressing or something like that.” (BMSM) |