Overview of the validated interview guide.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy that consists in the use of antiretroviral drugs by seronegative people at risk of HIV. Negative perceptions, inadequate understanding, and access barriers have been associated with decreased medication adherence. Manaus is the largest city in the Brazilian Amazon, where the incidence of HIV/AIDS is high, and the rates of adherence to the antiretroviral treatment for HIV and PrEP are low. In this qualitative study among PrEP users, mostly MSM, we explored perceptions, knowledge, and access barriers. We conducted 21 in-depth interviews with an intentionally sampled group of participants who had used PrEP at least once in their lifetime, selected through the snowball technique, between April and July 2022. A thematic analysis was conducted with a predominantly inductive approach. We highlight three relevant themes: (i) access to information about PrEP and its influences on users, (ii) access, monitoring, and barriers encountered, and (iii) facilitators for PrEP adherence and sexual behaviors. One of the negative perceptions identified in the study involves a misunderstanding of the association between PrEP users and the HIV/AIDS status. Participants revealed that some non-PrEP users suspect that individuals claiming PrEP usage are concealing an HIV-positive status to engage in unprotected sex. Lack of information by health professionals regarding HIV prevention methods poses significant barriers to PrEP access and adherence. Participants emphasized social media’s crucial role in PrEP awareness. The results suggest a need to increase digital outreach regarding PrEP, decentralize PrEP services, and provide comprehensive healthcare training to improve the effectiveness of the preventive measure.

暴露前预防（Pre-exposure prophylaxis, PrEP）是一种有效的HIV预防策略，指HIV易感血清阴性人群通过服用抗逆转录病毒药物实现感染预防。负面认知、认知不足以及获取障碍均与用药依从性下降密切相关。马瑙斯是巴西亚马逊地区规模最大的城市，当地HIV/艾滋病发病率居高不下，HIV抗逆转录病毒治疗及PrEP的用药依从率均处于较低水平。本项针对PrEP使用者（多为男男性行为者（men who have sex with men, MSM））的定性研究中，我们对其认知水平、知识储备及获取障碍展开了探索。研究于2022年4月至7月间开展，通过滚雪球抽样法招募了21名终身至少使用过一次PrEP的参与者并开展深入访谈，采用以归纳法为主的主题分析方法进行研究。最终确立三大核心研究主题：（i）PrEP相关信息的获取路径及其对使用者的影响；（ii）PrEP的获取、监测及面临的阻碍；（iii）PrEP依从性与性行为的促进因素。研究发现的一类负面认知涉及对PrEP使用者与HIV/AIDS感染状态关联的误解：部分未使用PrEP的人群怀疑，宣称使用PrEP的个体隐瞒了HIV阳性感染史，借此开展无保护性行为。卫生专业人员对HIV预防方法的科普不足，也成为PrEP获取与依从性提升的显著障碍。参与者还强调了社交媒体在提升PrEP公众认知方面的关键作用。研究结果表明，需加强PrEP相关的数字化科普宣传、优化PrEP服务的去中心化布局，并开展全面的医疗培训，以提升这一预防措施的实施效果。