Abstract
Background
While many HIV prevention services in South Africa specifically support women and girls, substantial gaps exist in HIV prevention, testing and treatment services targeting men and boys. We aimed to characterize HIV prevention knowledge, sexual-risk behaviors and interest in HIV pre-exposure prophylaxis (PrEP) among young men in rural KwaZulu-Natal.
Methods
Men were identified at community settings such as taverns, fast-food restaurants, and local stores. Interviews were conducted confidentially and anonymously in Zulu, and were recorded, translated and transcribed. Transcripts were coded to identify themes.
Results
Thirty-one HIV negative men (median age 26, IQR 23–31) were interviewed, 52% with a history of STI and 77% unemployed. While most (61%) perceived themselves to be at risk for HIV, less than half had tested for HIV in the prior 3 months (36%), the majority reported inconsistent condom use (87%), and most reported partners outside their relationship (84%). While only a quarter had previously heard of PrEP, all were interested in initiating. Four participants felt PrEP should only be for men because polygamy is acceptable. While most men wanted their partners on PrEP (77%), they also felt that their female partners initiating PrEP would signify a lack of trust in the relationship, while paradoxically acknowledging that their own multiple sexual relationships put their partner at risk. Men expressed fear of destabilizing new relationships by asking about HIV status, and admitted being less likely to discuss HIV status and condoms during sexual encounters involving alcohol. Men felt that using PrEP might lead to decreased condom use and enable their female partners to be sexually active with other men. Men were concerned that if they initiated PrEP they would be mistaken as HIV positive.
Conclusion
Men in heterosexual relationships in rural South Africa acknowledge engaging in high HIV risk behaviors and feel that they should have access to PrEP. They report contradictory perspectives about their female partners accessing PrEP, and are concerned about PrEP increasing HIV risk behaviors, which needs further exploration. Heterosexual men in sub-Saharan Africa should be targeted for combination HIV prevention services, including PrEP.
Disclosures
S. V. Shenoi, Amgen Pharmaceuticals: Spouse does part-time contract work, Salary.
Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons
