PrEP awareness and willingness to use oral PrEP among males ≥ 18 years attending VMMC services in Gauteng, South Africa

Abstract

Integration of voluntary medical male circumcision (VMMC) with pre-exposure prophylaxis (PrEP) services may increase access to and/or uptake of combination HIV prevention strategies. We examined awareness of and willingness to use oral PrEP among adult males attending VMMC services in Gauteng province, South Africa. A cross-sectional study was conducted among HIV-negative males aged ≥ 18 years seeking healthcare at one of six high-volume public VMMC clinics from June-October 2021. Participants provided written informed consent, completed an interviewer-administered questionnaire (covering demographics, clinical history, sexual behavioural and risk perception, PrEP eligibility, PrEP awareness and PrEP willingness), and underwent a rapid dual HIV/syphilis test. Logistic regression models (adjusted for education, age and sexual debut) were used to determine factors associated with PrEP awareness and PrEP willingness. Among the participants, 40% were at substantial risk of HIV and thus eligible for PrEP, 45% were aware of PrEP and 80% were likely/highly likely to use oral PrEP. Awareness of PrEP was lower among males who reported being at substantial risk of HIV than males not at substantial risk (aOR = 0.59, 95% CI: 0.41–0.86). PrEP willingness was higher in males who reported: (1) not being married, separated or widowed compared to married males (aOR = 2.28, 95% CI: 1.14–4.54); (2) being aware of PrEP (aOR = 1.91, 95% CI: 1.19–3.08) than those who were not aware of PrEP; and (3) having high/very high self-perceived HIV risk compared to those with lower self-perceived HIV risk (aOR = 1.94, 95% CI: 1.01–3.73). Considering the significant proportion of males attending VMMC who are at risk of HIV, integrating PrEP and VMMC services can significantly impact HIV prevention efforts by increasing awareness and uptake. Programs should prioritize PrEP awareness campaigns and highlight the combined benefits of VMMC and PrEP.