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The pros and cons of PrEP: Study Volunteers narrate their experiences in the ADAPT Study

Gay couples in civil marriage, love and relationship

TruvadaThe reasons that lead people to take forward the PrEP or not, and the reasons that cause them to take PrEP as prescribed or take it randomly or only once are likely to be very mixed, and largely depends on how the local cultural beliefs and political work in this direction, taking into account that are more personal factors such as relationship status, according to the Eighth International AIDS Society Conference on HIV pathogenesis, treatment and prevention (IAS 2015) heard yesterday.

The HPTN 067 (ADAPT) is a phase II open Truvada PrEP based in three cities around the world (Cape Town, Bangkok and Harlem, New York). The objective is to evaluate the ease of use and the feasibility of PrEP three different schemes: the daily dosage, timed dosage (meaning two drinks per week, plus an extra dose two hours after sex, when it does)And the dosage oriented events, which means a dose of two tablets 24 hours before the expected sex and, two hours later, should this occur.

For information on membership, pill use and HIV infection, see this report.

Each of the three city studies were also qualitative studies linked to it so that participants could relate prep taking experience.

Cape Town

Kapstadt bei NachtIn Cape Town, 18 179 of the men involved have depth interviews for researchers - six in a scheme arm, three in the first half of study and three near the end. There are also other six groups of seven participants each focus. Thus, 60 people, or about one-third of study participants gave qualitative information.

Rivet Amico at the University of Michigan, who led the qualitative study, said the attitudes of the participants in this and other prevention studies varied throughout the full support spectrum for complete confidence. Grip (the percentage of pills taken) and persistence (the length of time participants remained in the study as active participants) were compared to these attitudes. She said that attitudes about the study ranged from total distrust and avoidance pill to training and persons acting as champions of PrEP.

Factors that may affect particularly African participants incluindos the "Ubuntu" the belief that the value of an individual depends on their contribution to its surrounding community: the trial would be weighed against utility community standards.

Skepticism about the study was not necessarily bad: participants may be well aware that in a scientific study the outcome was uncertain; and may be afraid to take PrEP and distrust the integrity and reliability of the study and its researchers. These can be amplified or attenuated by the influence of the community and, especially, the other champions in PrEP or even anti PrEP advocates.

Distrust was more common in PrEP this and other studies in South Africa than in some other settings because participants were more likely to participate in the study for other reasons, such as medical benefits it offered, while not actually believe in benefit of PrEP. Participants may also act as advocates against PrEP. "I'll never drink [take] these pills because I do not trust them," he said.

"Exploration Careful" was the term most appropriate to the next category, which was not what they thought about PrEP and may be influenced by arguments for or against, with resulting irregular adherence. "I was getting confused and embarrassed because I do not know if I continue to take pills or not," said one participant.

Provisional acceptance characterizes the next group, which was motivated to try to take prep. His persistence was good, but they are often remembering to take the pills as something challenging: they were characterized by a determination to be good participants a sense of power: "I would not do it [ie, not taking the pills] because I want to see if these pills really work, "he said.

Property was not the best word to describe the attitude of the fourth group, which not only feels like participants who signed up, but as partners in a joint venture. They often acted as PrEPe champions saw how their work was good to combat negative perceptions and beliefs. One factor that African participants in the PrEP trials, in particular, have cited as a barrier to joining the assumption by the family and friends that someone taking antiretroviral pill should have HIV. One participant described his fight against these claims, "And I said, 'look here, ask me. And I do not dare say that I have HIV, telling everyone to this store. We are doing research here. '"

Rivet Amico said that depending on where they were in this spectrum, the usual membership and counseling strategies can help, but it can also be counter-productive. If someone was already suspicious of the trial, then asking them to address barriers to adherence can only build mistrust: the beliefs needed to be addressed rather than difficulties. Similarly, people who felt as partners and lawyers can feel helpless and feeling "down" to be constantly reminded of the importance of membership: instead, counseling can focus on supporting his defense. "Do not assume; people enter a study entitled "neutral" Amico said.

Bangkok wooden sign with a temple backgroundBangkok

Bangkok, 38 180 of men who have sex with men (MSM) involved took part in the qualitative evaluation of the study, 32 in six five-man focus group, and 6 in one-on-one interviews. They were not interviewed the end of the study.

The MSM in Bangkok study tended to talk more specifically about the pros and cons of three different regimes in terms of sex and relationships.

Presenter Tareerat Chemnasiri said that daily PrEP was preferred by many because there was no association with sex and it can be transmitted as another remedy "would be difficult to have a tablet before or after sex. My partner that the tablet was in favor. But the daily dose, I could tell it was a dietary supplement, "said one participant.

A number of participants stressed that not always have control over when they had sex, "My boyfriend always controls when to have sex, even if it often is not. So, I still have tablet two days a week and just hope that sex happens, "he said. With others, lack of opportunity and lack of control was the problem, and here the twice weekly dose made more sense: "I do not plan on sex, [but] the tablets with me all the time. "

One participant said that rather PrEP event-driven as it did not have enough sex to justify the daily dosage. But several others had difficulty with the post-sex, intermittent dose of PrEP: "After returning from the bar, took a tablet in 2 the right morning before having sex and I had to wait for 2 hours to take after sex dose to 4 I am already asleep then. "(This, incidentally, was one of the main problems cited by one of the few other studies of PrEP in MSM in a -a country not high yield, a small study done in Kenya).

One participant, however, said: I liked the intermittent PrEP because it really served as a warning for sex, almost an aphrodisiac, "I always ask to have sex with my boyfriend. Sometimes he says yes. Sometimes he's tired. But if I'm really horny like to have a tablet and get what you want

New York

New York City, financial business buildings in Manhattan on a laIn the study in New York 37 men participated in qualitative interviews with six in-depth interviews and focus groups in 31. Here, many of the participants also focused on the practical aspects of daily life or event-driven dosing. Many do not like the idea of ​​associating pills with sex, some just feel it "strange" if the other partner is not also taking a pill while some have found hostility: "My partners would be like," Why do you You are taking the pills? "[and] sometimes would never get to sex. Would just stop overnight. . They are crazy and out "Even some with steady partners, however, were forced to hide their PrEP:

"If you have a steady partner you know when you are going to do this or not. You can have [the pill]; "Wait, let me go to the bathroom" - pop. ... Because some people are not ready to accept things. They live in ... in a fantasy world where you do not think it can happen to you. "

However participants were also more concerned than the Thais to stigmatize gay men about their attitudes to other people, including health professionals, relatives and friends: once again, there was a widespread assumption that the participant must have HIV is they were taking a pill. "The tell them you are taking a pill to prevent it; they think you take a pill to stop it, "he said.

Participants had found the 'shame Slut "and the assumption that they should be promiscuous if they were taking PrEP, while others suspected that PrEP worked and therefore presupposes the existence of a person who took PrEP is higher risk than HIV: "One of my partners, like, 'ooo. What does that mean? What are you doing? . ", Indicating that the pill means I'm having unprotected sex left and right" "some of them were just like -" rather not have sex with you because I do not know if PrEP works, 'or' you probably It is a great whore. "

However, participants also described feelings of anxiety, relief, protection and empowerment with PrEP. One said he called his "Superman - the pill" while in again said, "I was protected. I wish [pill] was my older brother and I was getting beaten by the bully at school. "

Presenter Julie Franks of Columbia University said that interventions for HIV Stigma related to PrEP use context were needed for black men who have sex with men in the United States.

However, she added that "our mainly qualitative sample of Black MSM appreciated PrEP as a significant improvement in existing HIV prevention strategies."

Written by

Gus Cairns

Published: 22º July 2015

Panel at the symposium PrEP IAS

Translated by Claudio Souza from the original:The pros and cons of PrEP: trial volunteers recount Their experience of the ADAPT study

References

KR Amico et al. PrEP experiences Among South African women in the HPTN067 (ADAPT) study: Healthy paranoia (skepticism), Ubuntu, champions and challenges to resolving PrEP dissonance. Symposium presentation, Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Symposium on MOSY01. 2015.

A webcast of this presentation is available on the conference YouTube channel.

You can download the slides of this presentation from the conference website.

Chemnasiri T et al. Patterns of fri and PrEP in MSM Bangkok (HPTN 067 / ADAPT Study). Symposium presentation, Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Symposium on MOSY01. 2015.

A webcast of this presentation is available on the conference YouTube channel.

You can download the slides of this presentation from the conference website.

J Franks et al. Patterns of Fri and PrEP in MSM Harlem: A qualitative study (HPTN 067). Symposium presentation, Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Symposium on MOSY01. 2015.

A webcast of this presentation is available on the conference YouTube channel.

You can download the slides of this presentation from the conference website.

Where available, you can view details of sessions, view abstracts, download presentation slides and find webcasts using the conference 'Programme at a Glance' tool.

You can Also download PDF of the abstract book from the conference website

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