Understanding Pre-exposure Prophylaxis (PrEP) Use Among Men Who Have Sex with Men for Technological Design in Taiwan: A Qualitative Interview Study (Preprint)

BACKGROUND Pre-exposure prophylaxis (PrEP) can protect men who have sex with men (MSM) against HIV. However, the awareness and adoption about PrEP were low in Taiwan. One way to support and sustain patients’ PrEP use is through technological mediation. However, despite the prevalence of relevant technologies, little work has been conducted from the perspective of human-centered design to understand MSM’s needs and practices around PrEP so as to design useful and usable technological platforms for them. OBJECTIVE Our work intends to examine the practices of MSM who are current PrEP takers. We draw on the theoretical framework of social ecological model and propose theory-driven discussions and user-centered design implications for future technologies. METHODS We conducted in-depth interviews with 22 participants recruited through purposive sampling. Each interview lasted around 60 minutes and was audio recorded, transcribed, and analyzed with thematic analysis. RESULTS We identified three levels of influences, including individual, interpersonal, and sociocultural that shape the enablers, inhibitors, risks and challenges, and support towards MSM’s PrEP use. In general, the enabling factors include perceived self-risks, partner’s conditions, and the socially constructed notion of being gay and a high perceived susceptibility to HIV. The inhibiting factors are the concerns over PrEP’s effectiveness, its price, impression management of using PrEP online and offline, as well as associated negative implications about PrEP taking from the community. The risks and challenges were associated with participants’ switching of PrEP-taking styles, unscheduled sex practices with partner(s), and the general PrEP access. Last, the support our participants need is assistance with recording and reminding of medicine use; information, emotional comfort, and executive assistance provided by the healthcare professionals; and a healthy community where PrEP is recognized and supported. We also propose correspondent technological designs to support what we found based on the understanding about our participants. CONCLUSIONS It takes the whole society from multiple levels to promote and sustain target populations’ PrEP adoption. Our study identifies important factors at the individual, interpersonal, and sociocultural level about participants’ PrEP practices. We also suggest several technological design implications for future technologies to consider.