Sexual risk and HIV prevention choices among men who are mobile for work: Results from a rapid ethnographic assessment for the Mobile Men trial in South Africa and Uganda

In preparation for a trial implementing oral and long-acting Pre-Exposure Prophylaxis [LA-PrEP] for mobile men in South Africa and Uganda, we conducted a rapid ethnographic assessment at each trial site between November 2023 and July 2024. We present findings from that assessment on men's views on sexual risk and HIV prevention options which informed the trial. Each rapid ethnographic assessment took 15 days of continuous work in each community using a set of participatory methods: transect/spiral walks, ethnographic observations, conversations, in-depth interviews (IDIs) and focus/natural group discussions (GDs) with community members, health service providers and mobile men. We conducted 50 GDs, 61 IDIs and 297 informal conversations with men and women from four sites in Uganda and five in South Africa. Mobile men at the study sites were engaged in the transport industry (as taxi and truck drivers), construction and fishing. Many of these men were reported to be engaged in multiple sexual relationships. Being away from home, boredom and consumption of alcohol were reasons given for having many partners. Sex without a condom was widespread and was the preferred choice of the men because, they said, of increased sexual pleasure. None of the men was using PrEP. Men often said that PrEP was just for women. When given information on injectable and oral PrEP many men said that they would prefer injectable PrEP to avoid having to carry pills whilst travelling and, in addition, they would not have to remember to take pills. PrEP offers a convenient HIV prevention option for men who are mobile for work. The desire for condomless sex and the availability of oral and injectable PrEP may increase uptake. However, the associated risk of other sexually transmitted infections and blood borne viruses linked to not using a condom requires preventive interventions.