Why PrEP and why we want to reach specific communities

PrEP is a new tool in our efforts to stop the transmission of HIV in all affected communities.
PrEP offers almost 100% protection against acquiring HIV and can be easily used by both men and women, for anal and vaginal sex, the two main routes of HIV transmission in the UK.

Many of the tools available to us up until now have relied on one partner ‘agreeing’ to use protection for the benefit of the other partner. With PrEP, anyone can protect themselves without relying on a partner to use a condom.

Uptake of PrEP has been low among black African people despite those in this group being more likely to be diagnosed with HIV than heterosexuals of other ethnicities. In 2019, 37% of all heterosexuals diagnosed with HIV in the UK were black African men and women. This is despite the fact that less than two percent of the population identified as black African at the last census.

We have information from two campaigns about PrEP aimed at black African communities that gives us insight into the knowledge levels, attitudes about and access to PrEP in these communities.

Provided by six grassroots organisations from the black African community; Africa Advocacy, AAEGRO, African Health Policy Network, Embrace UK, FAWA and House of Rainbow.

The campaign set out to inform and advocate for people from black African communities about PrEP.

In the focus groups that were run it was identified that:

• Two-thirds of participants hadn’t heard about PrEP.
• People were very sceptical about PrEP and its effectiveness.
• There is a lack of messaging about PrEP aimed at black African communities.
• There are stigmatising messages associated with PrEP.

Feedback concluded that there is a need to:

• Demystify PrEP misconceptions.
• Normalise PrEP as a basic HIV prevention tool.
• Address issues around accessibility to PrEP for black African communities.
• Address stigma associated with PrEP in black African communities.

This campaign set out to inform people from black African communities about PrEP and to find out more about their thoughts and attitudes to PrEP. The campaign shows us:

• That knowledge levels about PrEP is extremely low among heterosexual black African (BA) populations in the UK, particularly when compared to PrEP knowledge levels in other highly affected groups like gay and bisexual men (or men who have sex with men).
• Because of the low levels of knowledge about PrEP, many people of BA ethnicity confuse PrEP with PEP, which is an intervention they do have knowledge about.
• For some BA people, PrEP is associated with negative personal beliefs about ‘promiscuous’ sexual behaviour and sex work. These negative beliefs can act as barriers to both their own access to PrEP and the access and use of PrEP for other BA community members they interact with.
• In the ‘PrEP Protects’ PrEP tool results, 0% of BA respondents said they ‘always’ use condoms.
• In the same  results, 53% of BA respondents said they ‘never’ used condoms and 100% of BA respondents did not know their partner’s HIV status.
• BA women were the most likely to say they ‘never’ use a condom (60%) yet were the most likely to have a sexual partner from a high HIV prevalence group (76%).

The ‘PrEP Protects’ campaign found that ‘there are very low levels of PrEP knowledge in BA people and misconceptions and confusions about who PrEP could benefit and the difference between PEP and PrEP needs addressing’ and that ‘all of the BA people that took part and completed the self-assessment tool attached to the study stood to benefit from PrEP.’

Community HIV services and community resources such as pharmacies offer us an opportunity to increase knowledge and uptake of PrEP for black African people who would benefit from it.

Trans men and trans women can also take PrEP. It will not interact with hormone treatments or cause fat redistribution in the face or body.

Advice is that daily dosing is the best option for trans people who want to use PrEP, whether they are having anal, frontal or neo-vaginal sex. [2]

People who take PrEP and miss a dose will still have high levels of the drug(s) in their bodies and therefore still have high levels of protection.

The best advice to give to people in this case is to take another dose when they remember and then continue with their usual dosing regimen.

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