Voicing the voiceless: exploring the communicative practices, attitudes and perceptions of black men who have sex with men (BMSM) in the Msunduzi Local Municipality towards pre-exposure prophylaxis (PrEP).

Abstract

Background: The approval of Truvada as Pre-Exposure Prophylaxis (PrEP) by the Medicines Council of South Africa in 2015, signalled a new beginning in the fight against HIV and AIDS especially for underserved key populations such as Men Who Have Sex with Men (MSM). Though this may be the case, there has been a protracted implementation which has been attributed to a lack of empirical research on the acceptability of PrEP amongst MSM in South Africa. This study, therefore, provides an overview of the general awareness, perceptions and attitudes and communicative practices of a sample of Black Men Who Have Sex with Men (BMSM) residing in the Msunduzi Local Municipality of KwaZulu-Natal, South Africa, hence making contributions to this area of research. Method: The study used a cross-sectional mixed-methods approach. Firstly, a questionnaire collecting data on socio-demographics, HIV status and sexual behaviours, PrEP awareness and adoption intention, as well peer health communication practices was carried out in English or IsiZulu amongst 120 MSM (109 BMSM) around Msunduzi. Univariate and bivariate statistical analyses were conducted on questionnaire data using IBM Statistical Package for Social Sciences (SPSS). Following this, 10 in-depth, semi-structured interviews were conducted in either English or IsiZulu and analysed, using the various phases of Thematic Analysis proposed by Braun and Clarke (2006). Results: Univariate analyses revealed that BMSM, in Msunduzi, were young, with a low Socio-economic Status (SES). Bivariate analysis established correlations between some socio-demographic characteristics, sexual behaviours and PrEP adoption intention. Although there was awareness and enthusiasm to adopt PrEP, this evolved into concerns about the implications PrEP could have on the quality of life of respondents, notably adherence self-efficacy. Dyadic communication between friends emerged as the main form of sexual health communication BMSM used to experience and validate their sexuality, discuss health prevention methods and influence behaviour change, including promoting the adoption of PrEP. Conclusion: There is significant potential for the implementation of PrEP amongst BMSM in Msunduzi Local Municipality. For effective implementation, more information and education are needed. Furthermore, the programme should address concerns such as PrEP’s impact on daily lives. Dyadic communication amongst friends and the use of social networks have the potential to encourage PrEP engagement and to increase adherence self-efficacy.