"A PrEP para mim tem sido como uma camisinha": Percepções de usuários sobre o uso da PrEP

Abstract

Objective: To analyze users9 perceptions of the facilitators and barriers to the use of HIV pre-exposure prophylaxis (PrEP) within a specialized care service (SAE). Methods: Qualitative study conducted with 20 PrEP users aged 18 years or older, who had been on continuous PrEP use for at least six months and were under regular follow-up at the SAE. Semi-structured interviews were conducted virtually. Interview transcripts were categorized using the clinical-qualitative content analysis technique. Results: We identified four main categories of facilitators: (i) well-being in relationships and sexual life, particularly emotional security and reduced concern about HIV infection; (ii) safety and protection, reinforced by the perception of PrEP effectiveness; (iii) person-centered care, evidenced by multi-professional support and the feasibility of appointments; and (iv) expectations regarding prophylactic advances, including acceptance of injectable PrEP and teleconsultation as potential improvements in care. Among barriers, the following emerged: (i) organizational gaps in reception and care, including limited access and poor quality of information provided; (ii) adverse effects and interactions with other substances, such as concerns about renal function and supplement use; (iii) social stigma, related to fear of exposure and discrimination; (iv) structural inadequacies in the service, such as lack of privacy, logistical challenges, and issues with medication dispensing; and (v) distrust of new modalities, such as on-demand PrEP, perceived as less safe. Conclusions: PrEP adherence is influenced by the balance between facilitators and barriers. Multi-professional support and the sense of protection provided by the prophylaxis contribute to its acceptance. In contrast, stigma, as well as organizational and structural challenges, hinder continued engagement in the program. Improvements in infrastructure, expanded access, reduction of social barriers, and the adoption of new technologies may enhance the impact of PrEP on HIV prevention.