1 2 The acceptability of PrEP to potential PrEP users (or candidates) to date has focused largely, although not exclusively, on the risk of inefficient PrEP use, such as low or inconsistent adherence to the medication and reduced condom use. It has also thereby focused predominately on experiences in the USA.3–5 There are currently a number of PrEP demonstration studies underway in the UK, Australia, the USA and elsewhere to explore how it might be used in ‘real world’ settings.6 7 Despite being available in the USA since the Food and Drug Administration (FDA) approved truvada (emtricitabine/tenofovir disoproxil fumarate) for use as PrEP in 2012, there has been relatively low uptake among
targeted communities affected by HIV, including gay, bisexual and other men who have sex with men (MSM).6 Moreover, PrEP has emerged as a controversial issue among those affected by HIV8 9 and there are clear global inequalities
in terms of access to PrEP as it is still only available off-label in a number of countries. There is a need to understand how uptake and use of PrEP as an HIV prevention strategy could be affected by a range of factors, such as community attitudes towards PrEP and the role of PrEP within concurrent HIV prevention strategies of potential PrEP users.10 11 We report on the first qualitative study in the UK of the acceptability of PrEP among populations most affected by HIV to inform targeted PrEP implementation strategies. Methods This article describes a mixed qualitative methods study on the acceptability of PrEP and treatment as prevention (TasP) with two communities in Scotland: (1) MSM and (2) men and women from migrant African communities (first generation immigrants including asylum seekers, students and other migrants). HIV is largely concentrated in these two communities in the UK, as they represent the highest levels of HIV prevalence.12 13 This article reports on findings in relation to barriers to PrEP use. Our sample included HIV-negative and/or untested
participants as potential PrEP users and HIV-positive participants as the potential or existing sexual partners of PrEP users. We include findings from HIV-positive participants because of evidence which indicates that serodiscordant sexual partnerships may be an important factor in PrEP acceptability.14 AV-951 HIV-positive individuals may shape PrEP uptake through influence on community attitudes, as well as more directly on potential HIV-negative sexual partners. First, exploratory focus groups (FGs) were conducted with a convenience sample of MSM and African participants between August and November 2012 to identify community attitudes and emerging issues around PrEP acceptability. We conducted seven FGs: five with MSM (n=22), and two mixed sex groups with African participants (n=11). Three FGs were conducted with HIV-positive MSM (n=14) and one FG with HIV-positive Africans (n=8).