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Characterising heterosexual men's demand for and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention in South Africa

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BACKGROUND: While most PrEP programs focus on reaching men having sex with men, high-risk heterosexual men may also benefit from PrEP. We piloted a project to increase awareness of PrEP among heterosexual men and then provide it to them through private clinics, with the aim of assessing their demographic and behavioural characteristics, interest in PrEP, and experience of PrEP use.
METHODS: Data were collected as part of an ongoing demonstration project in Johannesburg, South Africa. Community health workers engaged men on the street to discuss PrEP and link them to services. Private doctors then provided HIV testing and PrEP at no cost to clients. Routine intake and monitoring data were collected by community health workers as well as 10 participating practices from September 2021 (ongoing). We analysed data in StataIC to summarize relevant clinical, demographic, and behavioural characteristics. Research activities were approved by the Foundation for Professional Development Research Ethics Committee (FPDREC).
RESULTS: Demand creation reached 20,201 people. Among those reached, 19.8% had ever heard of PrEP, 91.9% were interested in learning more, and 56.3% were interested in trying PrEP. Within three months, 552 men had been initiated on PrEP. Of those, 59% were between ages of 25-39 years, and 47% were employed. Only 12% reported consistent condom use, with 24% never using condoms, and 61% using them inconsistently. 72% reported having more than one sexual partner in the past three months, with 45% reporting three partners or more. Alcohol use was reported by 64% and drug use by 11%. 48% percent of eligible clients had returned for a PrEP refill by end of the reporting period and 63% of those initiated were current users.
CONCLUSIONS: Early results of this study show low awareness of PrEP among heterosexual men but high interest once aware. Roughly three-quarters reported multiple sexual partners and inconsistent or no condom use, against a high background prevalence of HIV, making them good candidates for PrEP. Uptake and continuation rates were high, even with minimal follow-up support provided. Targeting high-risk heterosexual men with PrEP could have both individual and population-level benefits.