correlation between regularly drinking alcohol and the risk of engaging in UAI, hence significantly increasing the risk profile of these men (Lane et al., 2008b; Lane et al., 2011; Rispel et al., 2011b).
The above correlates to the concerns raised by BMSM in this sample about alcohol use and how being under the influence affects their decision-making capabilities. This reference to this impaired decision-making capability, sub-latently addresses issues of self-efficacy. This is one of the less-researched constructs of the HBM which refers to the individual’s confidence in their ability to act in a way and adopt a behaviour (Rosenstock, 1974b). The model asserts that this will influence an individual’s decision to take behaviour. If the individual has a high perceived self- efficacy, they will be prone to take necessary action or change a behaviour. Through the assertions of the BMSM in the current sample, it is emergent through the concerns about alcohol playing a role in affecting their decisions to consistently use condoms during sex. These comments subtly refer to a lack of self-confidence to maintain their chosen safe-sex behaviour considering their alcohol consumption. These findings raise questions with regards to PrEP and how self-efficient these BMSM will be if they start to use PrEP. The responses to the various questions are discussed in the following section.
indicates a deeper more personal and first-hand knowledge of not only the technical aspects but also what it looks like. What is alarming though is that the findings suggest that there was generalisable knowledge of PrEP. However, participants’ descriptions of what PrEP was, did not self-report any subtle instructions on how it is used or the regime to be taken. This can be argued to be indicative of a lack of full awareness of PrEP including its uses. When describing their knowledge of PrEP, interviewees asserting their knowledge of PrEP said:
There is a big technical term that is…Pre-Exposure Prophylaxis, but what it really is, is a preventative ARV really, you take ARVs to prevent the chances of you contracting HIV from another human being, really that is what the long and short of it is. Its ARVs same as the ones you take once you are HIV positive, but you just take this as a preventative dose yeah before engaging in sexual intercourse.
(Participant Six, Gay, Receptive Anal Intercourse Partner)
PrEP I think it’s those tiny blue pills that are used by someone who is not infected with HIV who is HIV negative that they use to protect themselves from HIV infection that is my knowledge of PrEP.
(Participant Seven, Gay, Receptive Anal Intercourse Partner)
Whilst the above quotes are indicative of most interviewees and their understanding of PrEP, there was a minority whose responses, and who admitted to being confused about the differences between PrEP and Post-Exposure Prophylaxis (PEP) this speaks to already identified concerns of incomplete knowledge as revealed in the questionnaires. Talking about this issue an interviewee said:
A friend of mine is on PrEP. I know that it reduces your chances of getting HIV. I know that it doesn’t reduce your chances of getting other STI’s such as chlamydia etc. I am still confused if it is the same drug that one can take if you feel that you have been exposed to HIV like in cases of condoms breaking etc. (Participant Nine, Gay, Receptive Anal Intercourse Partner)
Another participant confused the different methods by commenting that:
The thing that I know about PrEP is that I don’t know maybe I’m right maybe I’m wrong uhm…I can say that. Is it true that you have to PrEP first before you go to have sex and then you do sex and that
you can go for PrEP again? My understanding is that if you have had condomless sex you can go to PrEP in 72 hours I think and then you can be on PrEP… that’s what I can say from now. (Participant Nine, Gay, Receptive Anal Intercourse Partner)
The above two comments illuminate the information deficit that exists, specifically regarding information that competently addresses the differences between PrEP and PEP. Although the above BMSM exhibited an awareness about the intention of PrEP, the complexities of differentiating it from the different PEP existed.
At a subtle level, this confusion among participant’s highlights issues of lack of competent awareness of this prevention method amongst BMSM. These findings support an assortment of American studies (Brooks et al., 2015; Eaton et al., 2015; Eaton et al., 2017) suggesting that PrEP awareness may not be reaching the at-risk population that need it. Together, these studies outline that there is limited awareness of PrEP use across BMSM in various states. This view is further supported by Philbin et al. (2016) reporting a partial understanding of PrEP’s value, possible side-effects, and the regime for effective use.
Interviewees unanimously agreed that there was a dearth of information that was leading to a confusion of PrEP’s use and purposes.
No, there is not enough information because what I am finding is that in most of the campaigns that are available, the only thing these talk about is HIV and how people must get tested and if a person then happens to be HIV positive, the narrative is that they must go to the clinic and get their ARV, s.
There is no information out there on PrEP at all. There isn’t any knowledge. (Participant Seven, Gay, Receptive Anal Intercourse Partner)
I don’t think there is enough information because most people do not know about PrEP, that you can prevent HIV and that you can prevent HIV using PrEP. (Participant Seven, Gay, Receptive Anal Intercourse Partner)
Another interviewee commented:
There not enough information about it in the communities, within the LGBTI community, within the heterosexual community, every community in South Africa as a whole. I think the health system
[department] needs to give out more information on Pre-Exposure Prophylaxis because most people don’t even know what this pill does and don’t even know what it is for.” You come to people and be like hey you guys I’m on PrEP and they’ll be like what’s that? You see, and they don’t even know how to get it. (Participant Seven, Gay, Receptive Anal Intercourse Partner)