Participants described how PrEP would not adequately address thes

Participants described how PrEP would not adequately address these existing risks, and even had the potential to create significant new risks. Saberi et al27 reported similar moral concerns selleckchem Oligomycin A about the implications of PrEP on condom use in their

study with MSM participants in serodiscordant relationships in the USA. Although they surmise that proximity to HIV and age play a role in these concerns, our findings suggest that moral objections to PrEP were not limited by age or sexuality. We suggest that these moral reactions to PrEP as a risk-reduction option are related to broader social and community concerns about the potential for PrEP to radically change the way prevention is practiced.9 This highlights the need to engage with wider social concerns about what constitutes ‘inappropriate’ or high-risk sexual practice in relation to PrEP and to demonstrate how PrEP implementation can be a part of a safe and comprehensive risk management strategy. Our study has a number of strengths and limitations. We employed rigorous qualitative methodology which enabled in-depth exploration of the social meanings of PrEP acceptability and likely use.21 We therefore add to the existing quantitative PrEP acceptability research. With a small sample of MSM and migrant African participants in

a non-generalised HIV epidemic, some of whom were engaged in sexual health or community services, our findings are not generalisable to a wider population but we would argue, are transferable to similar populations in similar social contexts. As we did not sample according to sexual risk behaviour, our findings are only transferrable to broad risk groups and not necessarily

to ‘high risk’ individuals. Our inclusion of the recommendation to use condoms in the visual PrEP information may have biased the findings. However, our discussions included consistent and broad descriptions of PrEP and encompassed a wide range of PrEP scenarios, including non-condom use. Our research identifies the need to consider acceptability factors GSK-3 which extend beyond drug adherence and risk compensation when introducing and scaling up PrEP and has a number of implications for policy and clinical practice. In particular, it will be necessary to develop clear tools and techniques to communicate PrEP information to potential candidates, and to support health providers in the implementation of these tools. These methods will need to translate clinical research relating to PrEP effectiveness in real world contexts as is appropriate in the context of diverse critical literacy skills. Implementation will also need to address low-risk perception, non-HIV-related risk reduction and other moral concerns to demonstrate how PrEP can be a part of a safe and comprehensive risk management strategy.

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