Facilitators and barriers of HIV Pre-Exposure Prophylaxis use among four key populations in Iran

Abstract Background Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran. Methods We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV). We included HIV experts including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers related to PrEP implementation among KPs. Results We interviewed 7 FSW, 7 MSM, 4 PWID, 4 sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier’s theme emerged in three main categories including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers). Conclusions We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.