"At the end of the day I'd still have to use a condom!": A qualitative investigation of use of HIV pre-exposure prophylaxis among young gay and bisexual men in Nairobi, Kenya.

Despite availability of highly effective oral HIV pre-exposure prophylaxis (PrEP) for close to a decade, uptake and adherence among at-risk young men who have sex with men (YMSM) in Kenya, remain significantly low. This study investigated levels of PrEP knowledge, motivations, facilitators and barriers influencing PrEP initiation, persistence and adherence among YMSM, in efforts to optimise use and reduce risk of new HIV infections. In September 2021, 22 YMSM selected from 248 YMSM who had previously participated in an integrated bio-behavioural sexual health survey, took part in semi-structured in-depth interviews. Data analysis generated three key categories informed by the Information-Motivation-Behavioural skills (IMB) model: knowledge, motivation, and barriers influencing the use of oral and on-demand PrEP. Participants expressed PrEP awareness and effectiveness in HIV prevention, but were concerned about PrEP- and HIV-related stigma, with the fear that family, friends, and potential romantic partners might perceive them as being promiscuous, or as living with HIV. Participants reported being capable of seeking PrEP services provided in MSM-friendly facilities, with public health facilities perceived as hostile considering the criminalisation of, and societal stigma toward same-sex practices. These findings highlight the crucial need to re-strategise PrEP promotion not only as an effective but also a safe HIV-prevention option for at-risk populations. This study recommends expediting the integration of long acting lenacapavir and cabotegravir in the Kenyan health system as a means to diversify PrEP modalities and potentially reduce the stigma experienced in oral PrEP use.