Pre-exposure prophylaxis (PrEP) is a biomedical approach for preventing the acquisition of HIV in populations at substantial risk for HIV. PrEP acceptability has been high among the men who have sex with men (MSM) but the uptake and adherence has been low. The study seeks to determine the determinants of PrEP uptake among the MSM.
A cross-sectional exploratory study design was employed targeting MSM in Nairobi city and its environs. Purposive sampling was used to identify sites, where data was collected and snowballing technique employed to reach the respondents. The data was collected between November 2018 to June 2019.
Majority of the respondents were aged between 18-24 years at (64.75%). There was a significant association between frequency of HIV testing and ever used PrEP at a P- Value of 0.019. The place of last test and PrEP uptake was also associated at a P-Value of 0.019. A majority of the respondents at 181 (59.0%) indicated that they prefer blood self-test kit. Respondents who indicated that they prefer top were 132 (38.0%) with versatile being 142 (40.9%) and bottom at 73 (16.6%). Participants who were more aware of PrEP had a higher probability of taking PrEP at P-Value 0.002. There was an association between risk perception and taking PrEP at a P-Value of 0.0001. Some of the factors that hindered PrEP uptake include; Alcohol/drug use, there was a statistically significant association between anal sex after alcohol/hard drug use and never used PrEP at P-value of 0.027. Other factors include Stigma, discrimination, adherence and perceived side effects associated with the drugs.
Our study shows a number of factors facilitate PrEP uptake including; being a young MSM, inconsistent condom use, frequent HIV testing, being tested for HIV in a drop in centre, reporting frequent receptive anal intercourse, being aware of PrEP, perceived high risk of HIV infection and the believe about the effectiveness of PrEP. Barriers to PrEP uptake include; concomitant PrEP use with alcohol or hard drugs, stigma, discrimination, adherence, perceived PrEP side effects and medical mistrust.