Research into PrEP and heterosexual people

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Thursday 16th November 2017

In July PrEP became available on the NHS across Scotland. Since then nearly 400 people are known to have been prescribed PrEP on the NHS. There is clear guidance on who is eligible for PrEP in Scotland, and work must be done to ensure that all groups that could benefit from it and meet eligibility criteria are accessing it.

We know that more work needs to be done to understand HIV prevention needs and barriers to PrEP among key populations affected by HIV. As a starting point for this, we conducted a number of focus groups with heterosexual Africans at risk of HIV in Scotland. This was a first step to understanding the role of PrEP in their HIV prevention and we were only able to reach a small portion of heterosexual people who may be at higher risk of HIV. The findings from these groups confirmed that this area requires further focus and research.

From the focus groups we found that experiences of intersecting stigma created barriers for accessing HIV information and prevention services. Participants discussed how stigma played an integral role in their HIV prevention. Several participants shared with us how fear of stigma from friends or family seeing them at the sexual health clinic prevented them from attending services and that fear of being stigmatised by staff in sexual health services made them hesitant to discuss HIV prevention or PrEP.

When discussing awareness of PrEP, we found that the majority of participants had heard of PrEP but thought it was only for gay men. They felt there was no specific information targeted to make them aware that they could use also use PrEP. In a discussion of public messaging around PrEP, participants stated that messaging was in the right places (clinical and community spaces), but needed to show more diverse people and be culturally aware of the different ways communities experience HIV stigma and risk.

As part of this work we also interviewed three sexual health and blood borne virus clinicians who discussed the acceptability of PrEP amongst the heterosexual people using their services. The clinicians informed us that it is typically more difficult to identify HIV risk in heterosexual women than in heterosexual men. Additionally many heterosexual people have challenges in accessing and using HIV prevention, and have difficulties identifying their own risk.

This work was carried out by HIV Scotland to determine perception of HIV risk and awareness of PrEP among heterosexual people in Scotland. We were only able to reach a small portion of heterosexual people who may be at higher risk of HIV in this first step to understanding the role of PrEP in their HIV prevention. The persistent rate of new HIV infections among heterosexual people in Scotland, and the stories shared by this small cohort, indicates the need to undertake more research to ensure HIV prevention reaches more heterosexual people at the right time. As participants in these groups highlighted the issue of access to services and multiple stigmas act as barriers to accessing HIV information and prevention, future research should look further into these topics.