20th International AIDS Conference - Melbourne, Australia

Abstract

THPE271 - Poster Exhibition


“Prevention is more than just a method”: ARV-based prevention from the attitudes and behaviors of MSM and transwomen in light of the current conditions of public health services in Peru

E.A. Núnez-Curto Sifuentes, X. Salazar Lostaunau, C. Cáceres Palacios

Universidad Peruana Cayetano Heredia, Unidad de Salud, Sexualidad y Desarrollo Humano, Lima, Peru

Background: Pre-Exposure Prophylaxis (PrEP) and Early Treatment for Prevention (ETfP) are new strategies for HIV prevention, based on the use of antiretrovirals (ARV). They can improve prevention options and synergize with condom use in combination prevention programmes. In light of the publication of the 2013 WHO integrated guidelines for the use of ARV, this study indentifies and analyzes differential perceptions, barriers and needs for AVR-based prevention in the current conditions of the public health system and the services offered to key populations in Peru.
Methods: We conducted a qualitative study in Lima and Callao with potential users and stakeholders. Here we report on 8 in-depth interviews and 4 focus groups with potential users (MSM and transgender women -TGW)), 4 in-depth interviews with community leaders and 4 in-depth interviews with stakeholders.
Results: Participants have a fairly consistent knowledge about HIV, where condom use is still the epitome of prevention, although its use is still inconsistent. Knowledge of ETfP is almost absent in this population. Some knowledge of PrEP comes mainly from the iPrEX clinical trial. The lack of information, misconceptions and confusion reflect limited public discussion on new HIV prevention technologies in Peru. Worries about effectiveness, daily adherence, side effects and the generation of resistance are more common for PrEP than for ETfP. On an operational level, participants consider the need of well-trained physicians, other health providers, and peer counselors as part of a suitable program. Concerning potential implementation, while gay and other MSM demand more information on effectiveness and side effects, TGW consider that HIV prevention cannot be separated from expanded, improved health services for them.
Conclusions: Participants considered prevention as an individual responsibility, while their own health is their priority. It is unclear to what extent this varies in serodiscordant couples involving transwomen and MSM. Considering perceptions on effectiveness, side effects and adherence, implementation of ETfP is viewed more favorably than that of PrEP. Findings demonstrate the need for public discussion on these matters and straightforward information channels on ARV-based prevention targeting this key population.

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