Insights into barriers and facilitators in PrEP uptake and use among migrant men and transwomen who have sex with men in Belgium

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Abstract

Background

PrEP uptake is low among non-Belgian men and transwomen who have sex with men, although the HIV epidemic among men who have sex with men in Belgium is diversifying in terms of nationalities and ethnicity. We lack an in-depth understanding of this gap.

Methods

We conducted a qualitative study using a grounded theory approach. The data consists of key informants interviews and in-depth interviews with migrant men or transwomen who have sex with men.

Results

We identified four underlying determinants which shape our participants’ experiences and contextualize the barriers to PrEP use. These include (1) the intersectional identities of being migrant and men and transwomen who have sex with men, (2) migration related stressors, (3) mental health and (4) socio-economic vulnerability. Identified barriers include: the accessibility of services; availability of information, social resources and providers’ attitudes. These barriers influence PrEP acceptance and mediated by individual agency this influences their PrEP uptake.

Conclusion

An interplay of several underlying determinants and barriers impacts on PrEP uptake among migrant men and transwomen who have sex with men, illustrating a social gradient in access to PrEP. We need equitable access to the full spectrum of HIV prevention and care for all priority populations, including undocumented migrants. We recommend social and structural conditions that foster exercising these rights, including adapting PrEP service delivery, mental health and social support.

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Most cited references 39

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Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial

Sheena McCormack, David T. Dunn, Monica Desai … (2016)

Summary Background Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir–emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. Methods PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). Findings We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64–96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3–11·3). 13 men (90% CI 9–23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. Interpretation In this high incidence population, daily tenofovir–emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. Funding MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences.

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On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection.

Jean-Michel Molina, Catherine Capitant, Bruno Spire … (2015)

Antiretroviral preexposure prophylaxis has been shown to reduce the risk of human immunodeficiency virus type 1 (HIV-1) infection in some studies, but conflicting results have been reported among studies, probably due to challenges of adherence to a daily regimen.

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Grounded theory research: A design framework for novice researchers

Ylona Chun Tie, Melanie Birks, Karen D. Francis (2019)

Background: Grounded theory is a well-known methodology employed in many research studies. Qualitative and quantitative data generation techniques can be used in a grounded theory study. Grounded theory sets out to discover or construct theory from data, systematically obtained and analysed using comparative analysis. While grounded theory is inherently flexible, it is a complex methodology. Thus, novice researchers strive to understand the discourse and the practical application of grounded theory concepts and processes. Objective: The aim of this article is to provide a contemporary research framework suitable to inform a grounded theory study. Result: This article provides an overview of grounded theory illustrated through a graphic representation of the processes and methods employed in conducting research using this methodology. The framework is presented as a diagrammatic representation of a research design and acts as a visual guide for the novice grounded theory researcher. Discussion: As grounded theory is not a linear process, the framework illustrates the interplay between the essential grounded theory methods and iterative and comparative actions involved. Each of the essential methods and processes that underpin grounded theory are defined in this article. Conclusion: Rather than an engagement in philosophical discussion or a debate of the different genres that can be used in grounded theory, this article illustrates how a framework for a research study design can be used to guide and inform the novice nurse researcher undertaking a study using grounded theory. Research findings and recommendations can contribute to policy or knowledge development, service provision and can reform thinking to initiate change in the substantive area of inquiry.

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Author and article information

Contributors

Ella Van Landeghem: evanlandeghem@itg.be

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 19 April 2023

Publication date PMC-release: 19 April 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 712

Affiliations

[1 ]Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000 Antwerp, Belgium

[2 ]GRID grid.5284.b, ISNI 0000 0001 0790 3681, Department of Sociology, , University of Antwerp, ; Antwerp, Belgium

[3 ]GRID grid.11505.30, ISNI 0000 0001 2153 5088, Department of Clinical Sciences, Institute of Tropical Medicine, ; Antwerp, Belgium

Article

Publisher ID: 15540

DOI: 10.1186/s12889-023-15540-y

PMC ID: 10113984

PubMed ID: 37076823

SO-VID: 963438a2-62b4-490e-8161-73bcdfaecd4f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 26 October 2022

Date accepted : 27 March 2023

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ScienceOpen disciplines: Public health

Keywords: hiv prevention,prep,access to health care,migrants,belgium

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ScienceOpen disciplines: Public health

Keywords: hiv prevention, prep, access to health care, migrants, belgium

Insights into barriers and facilitators in PrEP uptake and use among migrant men and transwomen who have sex with men in Belgium

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Global Health Next Generation Network

Most cited references 39

Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial

On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection.

Grounded theory research: A design framework for novice researchers

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