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      Key factors in the acceptability of treatment as prevention (TasP) in Scotland: a qualitative study with communities affected by HIV

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          Abstract

          Objectives

          There is a clear need to understand the factors that might prevent and/or facilitate the effective use of HIV treatment as prevention (TasP) at an individual level. This paper reports on findings from the first qualitative study in the UK exploring the acceptability of TasP among gay, bisexual and/or men who have sex with men (MSM) and migrant African communities in Scotland.

          Methods

          We conducted seven exploratory focus group discussions (FGDs) with convenience samples of MSM (five FGDs, n=22) and mixed-gender African (two FGDs, n=11) participants. Of these, three FGDs were conducted with HIV-positive MSM (n=14) and one FGD with HIV-positive Africans (n=8). We then conducted 34 in-depth interviews (IDIs) with a purposive sample of MSM (n=20) and Africans (n=14, women=10). Half were HIV-positive (MSM, n=10; African, n=7). FGD and IDI data were analysed thematically drawing on predetermined and emergent themes.

          Results

          We found that inequalities in HIV literacy could be a barrier to TasP, as could social constraints, such as criminalisation of transmission, increased risk of sexually transmitted infection and increased burden of treatment. We also identified psychological barriers such as perceptions of risk. However, relationships and shared decision making were identified as potential facilitators for TasP.

          Conclusions

          Our results suggest that potential use and management of TasP may not be straightforward. It could be contingent on reducing inequalities in HIV literacy, minimising the perceived burden of treatment and other potential risks, and addressing the dynamics of existing and socially acceptable risk management strategies, especially in relation to long-term serodiscordant relationships.

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          Most cited references10

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          Focus groups in health research: exploring the meanings of health and illness.

          Focus group method is becoming increasingly popular among qualitative researchers. After introducing focus group method and briefly overviewing its use in health research, this article shows that the distinctive (and under-used) feature of focus group method is its generation of interactive data. Illustrating my argument with examples from health- related focus group research (including my own data on breast cancer), I argue that this feature makes focus groups an ideal method for gaining access to research participants' own meanings. Interactive data result in enhanced disclosure, improved access to participants' own language and concepts, better understanding of participants' own agendas, the production of more elaborated accounts, and the opportunity to observe the co-construction of meaning in action. Focus groups are, then, an ideal method for exploring people's own meanings and understandings of health and illness.
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            How Acceptable are Antiretrovirals for the Prevention of Sexually Transmitted HIV?: A Review of Research on the Acceptability of Oral Pre-exposure Prophylaxis and Treatment as Prevention

            Recent research has demonstrated how antiretrovirals (ARVs) could be effective in the prevention of sexually transmitted HIV. We review research on the acceptability of oral pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) for HIV prevention amongst potential users. We consider with whom, where and in what context this research has been conducted, how acceptability has been approached, and what research gaps remain. Findings from 33 studies show a lack of TasP research, PrEP studies which have focused largely on men who have sex with men (MSM) in a US context, and varied measures of acceptability. In order to identify when, where and for whom PrEP and TasP would be most appropriate and effective, research is needed in five areas: acceptability of TasP to people living with HIV; motivation for PrEP use and adherence; current perceptions and management of risk; the impact of broader social and structural factors; and consistent definition and operationalisation of acceptability which moves beyond adherence.
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              Mixing qualitative methods: quality assurance or qualitative quagmire?

              Although the advisability of combining qualitative and quantitative approaches has been questioned on the grounds of incompatibility of epistemological assumptions that underpin the two paradigms, mixing methods within the qualitative paradigm has been viewed as a more straightforward enterprise. This article challenges this view, highlighting the existence of several qualitative traditions, each with its own distinctive set of assumptions about what constitutes appropriate research questions; theoretical frameworks; research settings; relationships with those whom we study; techniques for eliciting data; form and content of data; and approaches to analyzing, presenting, and disseminating data. Multimethod qualitative approaches can be seen to occupy a contested domain. Analytical rigor would be strengthened by acknowledging and addressing the potentially contradictory assumptions on which one draws when seeking to combine qualitative methods. As qualitative researchers, it is incumbent on us to pay attention to context--not just in terms of the data collected but in terms of our own methodological positions.
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                Author and article information

                Journal
                Sex Transm Infect
                Sex Transm Infect
                sextrans
                sti
                Sexually Transmitted Infections
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1368-4973
                1472-3263
                June 2015
                8 December 2014
                : 91
                : 4
                : 269-274
                Affiliations
                [1 ]MRC/CSO Social and Public Health Sciences Unit, University of Glasgow , Glasgow, UK
                [2 ]School of Health and Life Sciences, Glasgow Caledonian University , Glasgow, UK
                Author notes
                [Correspondence to ] Dr Ingrid Young, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, UK; ingrid.young@ 123456glasgow.ac.uk
                Article
                sextrans-2014-051711
                10.1136/sextrans-2014-051711
                4453503
                25482649
                e4f8b20f-cd64-4b81-8381-dc3208fbdd7c
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 2 June 2014
                : 13 October 2014
                : 8 November 2014
                Categories
                1506
                Behaviour
                Original article
                Custom metadata
                unlocked

                Sexual medicine
                hiv,gay men,prophylaxis,qualitative research,public health
                Sexual medicine
                hiv, gay men, prophylaxis, qualitative research, public health

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