Galea, JT; (2014) Acceptability of rectal microbicides in men who have sex with men and transgender women in Peru and Ecuador. Doctoral thesis , UCL (University College London).

Abstract

Background: Globally, HIV epidemics continue to expand in men who have sex with men (MSM) and transgender women (TGW) for whom unprotected receptive anal intercourse is the primary HIV risk factor. An efficacious rectal microbicide could play a role in reducing incident infections in MSM/TGW; however, its real-world effectiveness will rely on correct and consistent use. Acceptability of rectal microbicides among these populations will dictate their use, and this must be understood within specific sexual, social, behavioural, and cultural contexts. MSM/TGW in Peru and Ecuador could benefit from a rectal microbicide, but acceptability of the technology is unknown. Methods: Mixed qualitative and quantitative methods were used to understand the barriers and facilitators of rectal microbicide use among 140 MSM/TGW in Lima and Iquitos, Peru and Guayaquil, Ecuador. Conjoint analysis assessed the relative and overall acceptability of eight different hypothetical rectal microbicides as well as the individual impact of specific product characteristics. Twelve focus group discussions and 36 in-depth interviews explored the sociocultural issues affecting rectal microbicide acceptability. Results: Conjoint analysis found that overall rectal microbicide acceptability was high (86.7 on a 0–100 scale) and that the product’s effectiveness had the single greatest impact on acceptability; other product characteristics (cost, side effects, frequency of use, formulation, dosage, prescription need) varied in influence by study city. Qualitative data were sorted into four domains: individual, product, interpersonal, and cultural-societal-structural. Key issues identified that could affect product acceptability were: limited product knowledge, concerns regarding prevention plausibility, side effects, and effectiveness; impact on condom use; target user; and, product access. Conclusion: Rectal microbicides for HIV prevention are acceptable to MSM/TGW in Peru and Ecuador but heavily influenced by product effectiveness. Real-world use will face multiple sociocultural issues, especially regarding access concerns, that must be accounted and planned for during development and eventual deployment of a commercial product.

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