Willingness to take PrEP among high-risk adolescent boys and young men in Masese fishing community, Jinja district, Uganda
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Introduction: Evidence shows that pre-exposure prophylaxis (PrEP) for uninfected persons for HIV prevention is among the most promising new approaches. While it has been demonstrated that high-risk groups such as men who have sex with men and transgender women are willing to take PrEP for HIV prevention, some communities have not embraced PrEP and literature on willingness among similarly high-risk groups like fisher folk especially adolescent boys and young men in fishing communities in Jinja district is hard to come by. Objective: To assess willingness to take PrEP among high-risk Adolescent Boys and Young Men (ABYM) in Masese fishing community and explore their understanding of PrEP in the context of HIV prevention. Methods: This was a mixed-methods study, cross-sectional in design conducted among high-risk ABYM from Masese fishing community in Jinja district between October and November 2020. High-risk ABYM were defined as males who reported sexual intercourse with two or more sexual partners concurrently in the last 12 months with inconsistent or no condom use; or used alcohol or drugs before sex. Quantitative data were collected on socio-demographic, sexual behavior and service access characteristics and willingness to take PrEP from 479 ABYM aged 10-24 years. Willingness to take PrEP was defined as responding with ‘likely’ or ‘very likely’to the question, “How likely is it that you would take PrEP to reduce your chances of getting HIV if it was provided?”. Quantitative data were entered into Epi-data (version 3.0) and exported to STATA (version 16) for statistical analysis. A modified poisson regression model was used to assess the factors associated with willingness to take PrEP and their corresponding 95% confidence intervals (95%CI) at 0.05 level of statistical significance. Qualitative data were collected from ABYM using focus group discussions (FGDs). FGDs explored participants’ understanding of PrEP as used in the context of HIV prevention and their willingness to recommend it to others. FGDs were audio-recorded, transcribed verbatim and analyzed thematically manually. Results: Of 479 ABYM with a mean age of 20.9 years (SD= 2.5), slightly more than three-quarters (77.4%, n=371) were single. More than half of the respondents had attained secondary level of education (56%, n= 268) or earned between Uganda shillings (UGX) 100,000 and 500,000 (58.5%, n= 280) monthly. Almost nine out of 10 (86.4%, n=414) respondents were willing to take PrEP. Of the 414 participants, 84.3% (n=349) would be willing to take PrEP even if they had to pay for it; 95.4% (n=349) if offered in oral form; 77% (n=319) if there was no stigma associated with taking it and 82.1% (n=340) if they were sure PrEP was safe. Risk perception (at very high risk: adjusted Prevalence Ratio [adj PR] =1.11; 95% CI: 1.03, 1.20), availability of PrEP in areas easily accessible by ABYM (adj PR=1.40; 95% CI: 1.25, 1.57) and confidence in PrEP safety (adj PR=1.56; 95% CI: 1.55, 2.24) were positively associated with willingness to take PrEP. On the other hand, marital status (being single: adj PR=0.92; 95% CI: 0.87, 0.98) and monthly income (earning more than UGX 100,000/=: adj PR=0.92; 95% CI: 0.87, 0.97) were negatively associated with willingness to take PrEP. Qualitative findings show that most of the ABYM had a limited understanding of PrEP despite the fact that they described PrEP as a drug used to prevent HIV. However, even if they knew what PrEP was used for, some of them could not differentiate between PrEP and Post-Exposure Prophylaxis. When asked if they would recommend PrEP to others, most ABYM were willing to recommend it to other users. Conclusion: There is high willingness (86.4%) to take PrEP among high-risk ABYM in Masese fishing community. Very high risk perception, availability of PrEP in areas easily accessible by ABYM and confidence in PrEP safety were positively associated with willingness to take PrEP while being single and monthly income above UGX 100,000/= were negatively associated with willingness to take PrEP. Interventions that target those who earn more than UGX 100,000/=, those who think they are at very high risk of HIV acquisition and single ABYM should be designed. PrEP should also be made accessible and assurance on PrEP safety given to ABYM to improve willingness to take PrEP. Sensitization to improve on the understanding of PrEP should also be carried out.