For PrEP to work successfully amongst BMSM and for it to reach optimal levels of efficacy as an HIV preventative tool it must be targeted at HIV negative BMSM. As highlighted by Avert.Org, PrEP is “a course of HIV drugs taken daily by HIV-negative people most at risk of HIV to reduce their risk of HIV infection”
(2018: para 1). Although this study explored a previously relegated population of BMSM and established a relative awareness and intention to adopt PrEP, this study relied on the self-reporting of intent and
awareness. Further medical research is needed that will involve testing for HIV to firstly establish the epidemics of BMSM in Msunduzi Local Municipality and ascertain if there is an actual target population that intends to adopt PrEP. Furthermore, more representative data on its actual acceptability, accessibility and affordability would be determined from a sample of BMSM who are eligible to take PrEP due to an HIV seronegative status.
An assortment of issues were raised by BMSM regarding motivators and barriers to uptake, the main motivator for a majority of BMSM although guised as protection from HIV. The subtle references made by respondents revealed that the social determinants such as being in a relationship and the dynamics that underpin the desire for healthier sexual choices within the confines of a relationship emerged as important.
Whereas a barrier that emerged saliently was adherence to a daily regime to maintain the protective efficacy of PrEP. These motivators and barriers offer fertile grounds for further research explorations, with specific reference to developing ways of addressing these concerns and laying them at bay through education campaigns.
Further research is needed to account for the varying need for prevented care that is determined by being in a relationship as opposed to more casual sexual engagements. The incongruency of a need for additional protection while in a relationship as opposed to much riskier multiple partners sexual engagement needs research that will better understand the social determinants that encourage this outlook amongst BMSM. This kind of research will also be beneficial the devising how PrEP could be communicated or marketed as a prevention method that has multiple uses and efficaciousness.
Furthermore, considerably more work needs to be done to determine sources of adherence and self-efficacy dissonance that were emergent amongst respondents in this study. Research is needed to determine and interrogate the social, biological and structural factors that influence this outlook. If PrEP is to be effectively implemented to successfully provide the protection clinical trials have exhibited, the impediments to uptake need to be rigorously explored and addressed through health education and other interventions.
Although, this study did not deeply engage participants on issues of marginalisation and discrimination that BMSM experiences, the findings exhibited that there is a considerable amount of BMSM in Msunduzi Local Municipality who have lower social economic status (SES). A large controlled populational survey would be the catalyst to establish the composition of Msunduzi MSM. This would give cues to the most accessible points of health care for the majority of BMSM in the municipality. This is needed to establish accessible points for implementation that would be inclusive of all men’s sexual identifications, with particular reference to straight-identified MSM who become invisible in MSM health care provision. Considering, the lack of research focus on Msunduzi Local Municipality, there is vast potential for the development of studies that could lead to the efficacious implementation and uptake of PrEP amongst this key population.
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