Abstract
Introduction
Men who have sex with men (MSM) are at higher risk of contracting HIV. Consensual anal sex (CAS) is the highest-risk sexual act for HIV transmission. All conceivable HIV prevention options ought to be made available, coupled with demand creation strategies intended to enhance the adoption and use of these interventions, to reduce HIV transmission among MSM. A unique and scientifically supported approach to overcoming obstacles to MSM adoption of current HIV prevention strategies (daily PrEP, male circumcision, condom use) is event-driven PrEP (ED-PrEP).
Purpose
This study investigates the knowledge, attitudes, and perceptions (KAP) of MSM towards event-driven PrEP (ED-PrEP) and explores relationships between socio-demographic characteristics, sexual risk profiles, and willingness to use ED-PrEP across five districts in South Africa.
Methods
A cross-sectional study was conducted with 295 MSM participants recruited from drop-in clinics across five districts in South Africa between April and June 2023. A structured online questionnaire assessed demographic information, HIV risk behaviours, and KAP regarding ED-PrEP. Descriptive statistics were calculated, and logistic regression analyses were performed to identify predictors of knowledge and attitudes towards ED-PrEP. Statistical significance was set at p < 0.05.
Results
The study found that 71.9% of participants had good knowledge of ED-PrEP, while 58% expressed a positive attitude towards its use. Logistic regression analysis revealed that sexual orientation (OR = 2.5, p = 0.03), perceived risk of acquiring HIV (OR = 3.8, p < 0.001), and education level (OR = 2.2, p = 0.002) were significant predictors of willingness to recommend ED-PrEP.
Conclusion
The findings highlight a high level of awareness and willingness to use ED-PrEP among MSM, particularly in urban districts. Targeted public health campaigns are recommended to enhance understanding and acceptance of ED-PrEP by addressing misconceptions and providing tailored information to improve uptake and adherence, ultimately contributing to HIV epidemic control.
References
Centers for Disease Control and Prevention. (2022). Population size estimates for MSM in South Africa [Internal report]. Unpublished.
Clarke, V., & Braun, V. (2013). Successful qualitative research: A practical guide for beginners. Sage.
Coulaud, P., Sagaon-Teyssier, L., M’madi Mrenda, B., Maradan, G., Mora, M., Bourrelly, M., Dembélé Keita, B., Keita, A. A., Anoma, C., Babo Yoro, S. A., Dah, T. T. E., Coulibaly, C., Mensah, E., Agbomadji, S., Bernier, A., Couderc, C., Laurent, C., Spire, B., Granouillac, B., & Dagnra, C. A. Y. (2018). Interest in HIV pre-exposure prophylaxis in men who have sex with men in West Africa (CohMSM ANRS 12324 – Expertise France). Tropical Medicine and International Health, 23(10), 1084–1091. https://doi.org/10.1111/tmi.13129
Dai, Y., Yin, Z., Li, C., et al. (2025). HIV pre-exposure prophylaxis re-initiation among men who have sex with men: A multi-center cohort study in China. Sexual Health, 22, Article SH24200.
European AIDS Clinical Society. (2018). Guidelines for treatment of HIV-positive adults (Version 9.1).
Evans, J. R., & Mathur, A. (2018). The value of online surveys: A look back and a look ahead. Internet Research, 28(4), 762–779. https://doi.org/10.1108/IntR-03-2018-0089
Fonner, V. A., Dalglish, S. L., Kennedy, C. E., Baggaley, R., O’Reilly, K. R., & Koechlin, F. M. (2016). Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS, 30, 1973–1983.
Gnambs, T., & Kaspar, K. (2015). Disclosure of sensitive behaviors across self-administered measurement procedures: A meta-analysis. Behavior Research Methods, 47(4), 1237–1259. https://doi.org/10.3758/s13428-014-0533-4
Jang, M., & Vorderstrasse, A. (2019). Socioeconomic status and racial or ethnic differences in participation: Web-based survey. JMIR Research Protocols, 8, e11865. https://doi.org/10.2196/11865
Lane, T., Raymond, H. F., Dladla, S., Rasethe, J., Struthers, H., & McFarland, W. (2011). High HIV prevalence among men who have sex with men in Soweto, South Africa: Results from the Soweto Men’s Study. AIDS and Behavior, 15(3), 626–634. https://doi.org/10.1007/s10461-010-9790-2
Nakiganda, C., Atukwatse, J., Turyasingura, J., & Niyonzima, V. (2022). Improving nurses’ knowledge on sepsis identification and management at Mulago National Referral Hospital: A quasi-experimental study. Nursing: Research and Reviews, 12, 169–176. https://doi.org/10.2147/NRR.S363072
Nyirenda, M., Abbai, N. S., Naidoo, J., & Ramjee, G. (2018). Sexual activity and healthcare-seeking behaviour: A cross-sectional study of older adults in an HIV-endemic South African setting. Southern African Journal of Demography, 18(1), 7–57. https://www.jstor.org/stable/90022347
Pienaar, J. (2022). PrEP uptake among MSM in SA: Programmatic data from PEPFAR projects [Internal CDC report]. Unpublished.
Plotzker, R., Seekaew, P., Jantarapakde, J., Pengnonyang, S., et al. (2017). Importance of risk perception: Predictors of PrEP acceptance among Thai MSM and TG women at a community-based health service. JAIDS Journal of Acquired Immune Deficiency Syndromes, 76(5), 473–481. https://doi.org/10.1097/QAI.0000000000001536
Stone, J., Mukandavire, C., Boily, M. C., Fraser, H., Mishra, S., & Schwartz, S., (2021). Estimating the contribution of key populations towards HIV transmission in South Africa. Journal of the International AIDS Society, 24, e25650. https://doi.org/10.1002/jia2.25650
Voligno, G., Gualano, M. R., Lo Moro, G., Bert, F., & Siliquini, R. (2020, October). Effects of COVID-19 lockdown on mental health and sleep disturbances: Results from an Italian survey. In 16th World Congress on Public Health.
Vuylsteke, B., Reyniers, T., De Baetselier, I., Nöstlinger, C., Crucitti, T., Buyze, J., Kenyon, C., Wouters, K., & Laga, M. (2019). Daily and event-driven pre-exposure prophylaxis for men who have sex with men in Belgium: Results of a prospective cohort measuring adherence, sexual behaviour and STI incidence. Journal of the International AIDS Society, 22(10), e25407. https://doi.org/10.1002/jia2.25407
World Health Organization. (2019). What’s the 2+1+1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men: Update to WHO’s recommendation on oral PrEP. Geneva: World Health Organization.
Yi, S., Tuot, S., Mwai, G. W., Ngin, C., Chhim, K., Pal, K., Igbinedion, E., Holland, P., Choub, S. C., & Mburu, G. (2016). Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle-income countries: A systematic review and meta-analysis. Journal of the International AIDS Society, 20(1), 21580. https://doi.org/10.7448/IAS.20.1.21580
Zheng, M., He, J., Yuan, Z., Zhang, X., Yao, Y., Fang, X., Fu, L., Ding, Y., He, N., & Zhang, Y. (2020). Risk assessment and identification of HIV infection among men who have sex with men: A cross-sectional study in Southwest China. BMJ Open, 10(11), e039557. https://doi.org/10.1136/bmjopen-2020-039557

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