Misconceptions and limited experience with HIV pre-exposure prophylaxis (PrEP) among fishermen in Western Kenya: a qualitative study

Daily oral HIV pre-exposure prophylaxis (PrEP) is highly effective when taken consistently, but its uptake remains low among mobile fishermen in Kenya. This study explored barriers and facilitators to PrEP uptake in three Lake Victoria beach communities. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with 65 fishermen, purposively sampled by community, age and study arm. IDIs and FGDs examined PrEP knowledge, perceptions and experiences and were conducted in Swahili or Dholuo, transcribed and translated into English. Data were analyzed using a framework approach. Most participants were >35 years old (56%), married (83%) and half (48%) had completed primary education or higher. Although most had heard of PrEP, some confused it with post-exposure prophylaxis, and many were unsure of correct dosing and eligibility. Barriers to uptake included anticipated partner conflict, confusion with HIV treatment medications and stigma associated with PrEP use, leading to fear of disclosing use to sexual partners. Facilitators included a preference for PrEP over condoms and its perceived protection in sero-different partnerships. Despite free availability in clinics, misconceptions may hinder uptake. Educational interventions are needed to improve PrEP knowledge and reduce stigma, especially among mobile populations like fishermen.