Acceptability of oral versus rectal HIV preexposure prophylaxis among men who have sex with men and transgender women in Peru

Objective: Oral preexposure prophylaxis (PrEP) with antiretrovirals (ARVs) is at the forefront of biomedical HIV preventionresearch, and ARVs are also being tested for rectal administration to target people practicing unprotected receptive analintercourse (URAI) and at risk of HIV infection. This study assessed the acceptability of daily oral PrEP and rectal PrEP duringURAI among men who have sex with men (MSM) and transgender women (TGW) in Peru. Methods: During the 2008 HIVsentinel surveillance survey conducted in 3 Peruvian cities (Lima, Iquitos, and Pucallpa), MSM and TGW reported being"versatile," "most of the time receptive," and "exclusively receptive" during anal sex behavior where surveyed on theiracceptability of oral and rectal PrEP. Results: Among 532 individuals, high acceptance of either oral (96.2%) or rectal (91.7%)PrEP products was reported. If both products were efficacious/available, 28.6% would prefer a pill, 57.3% a rectal lubricant,and 14.1% either. A trend toward higher acceptance was observed as receptive anal sex behavior exclusivity rose (P=.013).Being receptive most of the time (adjusted odds ratio [aOR]: 9.1, P=.01) and exclusively receptive (aOR: 7.5, P=.01),compared to being versatile, were independently associated with oral PrEP acceptability. A similar association was found withthe acceptability of rectal formulations (aOR: 2.3, P=.07; and aOR: 2.5, P=.02; respectively). Conclusions: Oral and rectalPrEP were highly acceptable among Peruvian MSM and TGW, particularly among those at the highest HIV infection risk.These data can guide the implementation of PrEP programs in Peru and similar settings and populations.