Black men who have sex
with men (MSM) in London experience a unique set of motivations and barriers to
using pre-exposure prophylaxis (PrEP), according to the results of a recent
qualitative study published in Sexually
Transmitted Infections.
This research was carried out by T. Charles Witzel
and colleagues at the London School of Hygiene and Tropical Medicine.

Black MSM who had very mixed social
groups in terms of sexual orientation and ethnicity tended to report limiting
discussions about sexual health to their gay male friends. Racism and exclusion in both online and
offline gay spaces were barriers to coming into contact with PrEP messaging. Stereotypical understandings
of PrEP use intersected with racist ideals of black male sexuality, limiting
self-identification as a potential PrEP user. On the other hand, some men viewed PrEP in a positive light as
it was seen as a way of mitigating risk.

Black MSM in the UK
have higher rates of HIV incidence and prevalence, despite similar risk
profiles when compared to other MSM. A
cross-sectional study showed that 2.8% of black MSM were diagnosed with HIV
versus 1.1% of overall MSM in the preceding year.

Prior research identified
prohibitive costs, lack of risk perception, unacceptable clinical services,
concerns about side effects and issues regarding stigma as the primary barriers
to accessing PrEP for a range of MSM. Perception of high risk behaviour and the
pleasure associated with condomless sex were important motivators when it came
to men seeking out PrEP. Specifically for black MSM in London, factors such as
preferred clinic locations outside their home communities and the skill and
empathy of clinical staff were important.

Currently in England,
PrEP is available to 13000 participants enrolled in the IMPACT
trial
. During data collection for this qualitative study (2016), it
had only been available to 550 participants enrolled in the PROUD
trial
. However, many MSM in the UK have accessed generic forms of
PrEP from alternative sources, such as ordering it online.