Assessment of Perception of Men Who Have Sex With Men on Utilization of Pre-Exposure Prophylaxis: A Case of Sex Workers Outreach Programme in Nairobi, Kenya

Abstract

The study assessed the perception of Men who have sex with men on the utilization of Pre-exposure prophylaxis. A case of Sex workers outreach program, Nairobi, Kenya. The objective of the study was to Assess the PrEP knowledge level of MSM and its influence on the utilization of PrEP, examine the attitude held by MSM and its influence on the utilization of PrEP, and investigate the constraints that hinder MSM from utilizing PrEP. The study utilized the Health Belief Model, ecological model, and Social Cognitive Theory to guide the study outcome. The study utilized a descriptive research design with both qualitative and quantitative approaches and the study population was 6232 Men who have sex with men, a sample size of 147 and 28 key informants in the Sex Workers Outreach Program in Nairobi County, Kenya. Interview schedules and key informant guides embedded in a KOBO Tool Box were used in data collection. Quantitative data was analyzed using the statistical package for the Social Sciences (SPSS), version 24 and qualitative data was analyzed thematically. Regarding PrEP knowledge, 135(92%) of the respondents had heard of PrEP and 12(8%) had not. Of the respondents who had heard about PrEP 133(99%) knew what PrEP is and 2(1%) did not know. Of the 99% who knew what PrEP is 113(85%) had ever used PrEP for HIV prevention and 20(15%) had never used it. In terms of attitude towards PrEP, 132(89.8%) of the respondents agreed that PrEP was effective in HIV prevention and 15(10.2%) disagreed about it and 123(83.7%) of the respondents felt secure about their sexual health when they utilize PrEP as compared to 24(16.3%) who are insecure about it. In regards to the challenges, 20(13.6%) of the respondents faced intimate partner violence, 64(43.5%) stigma and discrimination from family and friends, 1(0.7%) stigma and discrimination from HCW, 3(2.0%) shortage of PrEP drugs, 30(20.4%) PrEP drug side effects and 29(19.7%) other challenges which included distance to the clinics. In addition, 24% of MSMs reported product stigma associated with PrEP, whereas 76% did not. This implies that, while the majority of respondents do not perceive stigma from using PrEP, approximately one-quarter of the population does and 42% of MSMs experienced stigma as a result of the PrEP bottle's labelling, whereas 58% did not. This suggests that a sizable proportion of the MSM population feels stigmatized by the way PrEP bottles are labelled, possibly because the labelling makes the medication easily identifiable as HIV prevention. It was concluded that there is a high PrEP knowledge implying PrEP information is well disseminated and accessible. In addition, there is a high level of confidence in PrEP effectiveness and stigma and discrimination from family and community are common and highlight the social pressure and negative attitude that MSM face. The study recommended enhancing and concentrating on maintaining and broadening MSM PrEP education by providing accurate and up-to-date information, intensifying screening of intimate partner violence, and educating healthcare providers to intensify pre-and post-initiation counselling to address fears, insecurities and side effects.