Men’s Voices on Long-Acting Pre-Exposure Prophylaxis Delivery Modalities: Acceptability and Preferences Among Cisgender Men and Men Who Have Sex With Men in South Africa

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Introduction: In sub-Saharan Africa, cisgender men—in particular men who have sex with women (MSW) and, to a lesser degree, men who have sex with men (MSM)—are often under-represented in HIV prevention research, despite their own HIV risk and role in transmission cycles. As HIV prevention research on long-acting pre-exposure prophylaxis (LA PrEP) options expands in sub-Saharan Africa, it is essential to engage these populations to ensure their acceptability. We investigated perceptions of implants and intramuscular injectables as LA PrEP delivery among MSW and MSM. Methods: In-depth interviews were conducted between October 2020 and March 2021 with 40 MSW (n = 20) and MSM (n = 20), aged 18–35 years, self-reported as HIV negative, sexually active, and residing in resource-restricted communities in Cape Town and Johannesburg, South Africa. We explored factors influencing LA PrEP attitudes. Data analysis followed a thematic framework approach. Results: MSW and MSM found LA PrEP administration modes more acceptable than daily oral PrEP because they offered longer lasting protection while reducing frequent clinic visits for refills. MSW voiced hesitancy around the use of “foreign products,” fearing infertility and congenital disabilities in their future children. Both subgroups acknowledged the convenience of implants with long-dosing duration, but injections were deemed to be more discrete and familiar. Both groups described implant use as potentially stigmatizing, with a greater chance of causing tissue scarring from insertion and removal procedures. Conclusions: Evidence relating to men’s engagement in HIV prevention and acceptable modalities of HIV prevention is limited. We found that both groups were enthusiastic about LA PrEP, informing the development of our subsequent clinical study to provide further insight into using placebo versions of LA PrEP and future implementation of LA PrEP options.

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