Perspectives on HIV prevention of people with a recent HIV acquisition: a qualitative study at the HIV Clinic in Antwerp, Belgium
1. Abstracts based on Formal Research WorkChristiana Nöstlinger1, Ella Van Landeghem1, Thibaut Vanbaelen2, Maartje Van Frankenhuijsen2, Lida van Petersen2, Bernadette Hensen1, Thijs Reyniers1
1 Institute of Tropical Medicine, Department of Public Health, Sexual Health and HIV Research Unit, Antwerp, Belgium
2 Institute of Tropical Medicine, Department of Clinical Sciences, HIV and STI Clinic, Antwerp, Belgium
Abstract
Introduction
After a decade of decline, the number of new HIV acquisitions have risen for three consecutive years in Belgium, despite PrEP being rolled out since 2017, alongside other HIV prevention strategies. The aim of this study was to get a better understanding of possible reasons for the increasing trend and to explore individual perspectives on missed opportunities for HIV prevention among people who recently acquired HIV.
Methods
In this qualitative study, we purposively selected individuals with a recent HIV acquisition (<12 months) in the HIV clinic of Antwerp for an in-depth interview, reflecting the distribution across gender, age and sexual orientation, and until reaching data saturation. During the interview, we explored experiences and attitudes towards HIV prevention, PrEP awareness and past willingness to use it, HIV risk perception, circumstances of HIV acquisition, and challenges related to HIV prevention. Interviews were transcribed verbatim, and inductively analysed using a reflective thematic approach. Emerging themes were codified guided by the socio-ecological model to disentangle factors at different levels.
Results
We interviewed 21 individuals between April 2024 - January 2025 (18 men, 3 women; mean age 38 years). Sixteen participants identified as men who have sex with men (MSM), and 5 as heterosexual. Five had a migration background. All MSM had previous negative HIV tests, 5 participated in chemsex, and 3 had ever used PrEP before but stopped; none of the heterosexual people did either of them. The stories were very diverse, and while most had positive attitudes toward HIV prevention, several challenges were identified at multiple levels. At INDIVIDUAL level, several participants indicated limited knowledge of PrEP or not feeling at risk for HIV, in particular heterosexual and migrant individuals. Some MSM perceived HIV as less threatening nowadays. A few mostly young MSM were concerned about the costs of PrEP, and its impact on health. Feelings of loneliness, depression or fear (of rejection) were specific vulnerabilities leading to reduced protection during sexual contacts. This latter interacted with factors at INTERPERSONAL level, such as negative social norms of MSM towards condoms and PrEP, and participating in chemsex leading to losing control. Two participants revealed undue confidence in steady partners, who did not tell they were HIV-positive or had risky sexual contacts outside the relationship. Two heterosexual people mentioned sex workers not proposing to use condoms. At HEALTHCARE level, participants described not being approached to consider PrEP by their GP or outreach services. At INSTITUNIONAL level, an important legal barrier cited by migrant individuals was not having access to PrEP due to a lack of health insurance.
Discussion
This study provides several useful insights to improve HIV prevention and mitigate missed opportunities. Promising strategies may include influencing social norms in MSM communities toward condoms and PrEP (through campaigns or opinion leaders); a tailored approach for people with a migration background; a pro-active role for GPs to discuss PrEP; ensuring access to PrEP for uninsured people; recommending chemsex users to start PrEP; using HIV-testing as an opportunity for PrEP counseling; and reengaging former PrEP users.