The developing countries have specific characteristics that, in general, do not appear in studies with PrEP carried out in the United States and Europe. Attempting to detect such factors means to enhance the possibility of dissemination of PrEP in such places.
From such demand, the article Conhecimento prévio e disposição em usar a PrEP entre HSHs de países de renda baixa e média: um estudo sistemático e meta-análise (Previous Knowledge and readiness to use PrEP between HSHs of low- and medium-income countries: a systematic review and meta-analysis) considered he results of 23 studies with PrEP carried out between 2011 and 2016. Such database served to a comparative study (meta-analysis) with the main purpose of assessing to which extent HSHs would be willing or not to make PrEP. In total, 10,040 HSHs from the following countries were included: Brazil, China, India, Kenya, Malaysia, Burma, Peru, Thailand, Uganda, Vietnan, and South Africa.
The authors of the article noted, in general, a low previous awareness of PrEP – an average of 29.7% users. Such number, however, was not homogeneous, since while India did not record no incidence of awareness of PrEP among the participants, in Brazil, such number was 61.3% users. Among the factors that could be pointed out as facilitators to be aware of PrEP are: being of age, having more years of formal instruction, and frequently using the internet as information source.
Even with such low index, a general average of 64.4% showed interest in using PrEP. Once more, such number considerably varied between the countries – 19.1% in China and 96.2% in Peru.
Another comparison parameter considered by the article was to what extent the side effects could remove potential users of the prophylaxis. In Thailand, 39.2% showed initial interest; however, after the explanation about possible effects, such number was reduced to 24.6%. However, in China, 44.7% of the participants were afraid regarding the effects in their diets and sleep, while in Brume the most recorded concern was about the consequences of using the drugs of PrEP during a long time.
Questions about the efficacy were also analyzed by the authors of the article. Once more, there was a huge variation between the countries: while in China, 44.1% questioned the effectiveness of PrEP in protecting against HIV, the number of Malaysia to the same question was 9.8%.
The need of a frequent use of the drug appeared as a barrier in some studies. The demand for a daily dose and the difficulty of getting adapted to such routine is a factor that discourages some potential users, although not being a unanimity. HSHs of India and Peru showed more interest in injectable PrEP than in oral dose, while studies carried out in South Africa present a preference for the daily pill.
The fear of stigmatization for taking drugs related to HIV is also a factor that takes potential users away. In addition to such concern, the fear of being publicly recognized as a man that makes sex with men or a promiscuous man appeared in a relevant manner in many volunteers. It is applicable to remember that in some developing countries considered by the study – such as in India and Brume –, the sexual intercourse between people of the same gender is criminalized.
Among the analyzed topics, one that most called the attention of the researches of the article was the relationship between the low prior knowledge of PrEP compared to a high interest in such method after knowing it better. In Brume, while only 5% of the volunteers were aware of PrEP before participating in the research, 62% showed interest in using it; in Brazil, the ratio was 61.3% to 82.1%. According to the authors of the text, such variation may be pointed out as one of the main characteristics of countries that have not had experience with PrEP outside controlled studies yet. The majority of the developing countries fits in such profile, to the contrary to places such as the United States and Europe. Structural, social, and sometimes legal factors also appear as decisive barriers to be overcome for the implementation of PrEP.
Link to the summary: https://www.ncbi.nlm.nih.gov/pubmed/28691439
Source of the image: https://www.childrenandaids.org/PrEP-testing
 Original title: Awareness and willingness to use HIV pre-exposure prophylaxis among men who have sex with men in low- and middle income countries: a systematic review and meta-analysis.
 Such topic assesses to what extent the volunteers were aware of PrEP and its operation before entering a study.