‘Until we tell them, they will not understand’: conversations about HIV pre-exposure prophylaxis with sexual minorities in Delhi, India

HIV pre-exposure prophylaxis (PrEP) is not widely available in India. We explored the needs and perspectives of men who have sex with men (MSM) and transgender persons about PrEP in Delhi, India. We accessed these key populations through targeted intervention (TI) projects for HIV prevention in Delhi. We conducted three focus group discussions (FGD) with community members, and four in-depth interviews (IDI) with key informants. We coded them using deductive and inductive reasoning, including constructs from the information-motivation-behavioural skills model for HIV prevention. Eleven MSM and 16 transgender persons (median age 24 years) participated in FGDs. Participants were mostly unaware of PrEP and considered condoms the mainstay of HIV prevention. Upon explaining PrEP, they considered adopting it as additional protection. Participants stressed the need to disseminate information about it through social media and dating apps. Motivation to adopt PrEP could be influenced by long-term partners, side effects, privacy and stigma. Adherence and concomitant condom use would be behavioural challenges. Affordability could be a barrier for access. For PrEP scale-up in India, the health system would need to communicate risks and benefits to key populations, integrate PrEP with HIV preventive services, consider product preferences, and ensure financial support and confidentiality.