Beyond <scp>HIV</scp> prevention: everyday life priorities and demand for Pr<scp>EP</scp> among Ugandan <scp>HIV</scp> serodiscordant couples

Joloba, Moses; Pisarski, Emily E; Wyatt, Monique A.; Muwonge, Timothy; Asiimwe, Stephen; Celum, Connie; Baeten, Jared M.; Katabira, Elly; Ware, Norma C.

doi:10.1002/jia2.25225

Cited by 37 publications

(30 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this regard, PLHIV and their sexual partnerships should receive counseling and education with serodifferent couples about these HIV prevention options in isolation or their association with other risk management and prevention methods such as PrEP and condoms ( 48 ) .…”

Section: Discussionmentioning

confidence: 99%

Inconsistent condom use between serodifferent sexual partnerships to the human immunodeficiency virus

Reis

Melo

Fernandes

et al. 2019

Rev. Latino-Am. Enfermagem

View full text Add to dashboard Cite

Objective: to analyze predictors of inconsistent condom use among HIV-positive people with sexual immunodeficiency virus serodifferent sexual partnership. Method: cross-sectional, analytical study with a consecutive non-probabilistic sample consisting of people living with the human immunodeficiency virus with serodifferent sexual partnership and who were in outpatient clinical follow-up. Data were collected through individual interviews guided by a semi-structured questionnaire and subsequently analyzed with bivariate analysis and logistic regression. Results: Seven variables were independently associated with inconsistent condom use. Schooling less than 11 years of schooling (4.9 [2.4-10.1]), having multiple partnerships (5.0 [1.3-19.6]), using alcohol (2.1 [1.1 -4.4]) or other drugs (2.8 [1.2-6.3]), do not receive advice from a healthcare professional (2.0 [1.1-3.9]), have no knowledge of treatment as prevention (3.0 [1,2-6,9]) and not knowing that undetectable viral load reduces the risk of human immunodeficiency virus transmission (3.8 [1,1-13,7]) were predictors for inconsistent condom use. Conclusion: The study showed that psychosocial factors interfere with consistent condom use between serodifferent partnerships. Thus, it is highlighted that there is a need for comprehensive interventions that include the integration of clinical and psychosocial care.

show abstract

Section: Discussionmentioning

confidence: 99%

Inconsistent condom use between serodifferent sexual partnerships to the human immunodeficiency virus

Reis

Melo

Fernandes

et al. 2019

Rev. Latino-Am. Enfermagem

View full text Add to dashboard Cite

show abstract

“…While PrEP is nearly 100% effective at preventing HIV infection when adherence is high, the counseling delivered with PrEP in the Partners Demonstration Project still emphasized the importance of continued condom use to prevent pregnancy, STIs, and as a backup for HIV prevention [23,24]. HIV serodiscordant couples have reported the use of condoms as a barrier to establishing intimacy and closeness within the relationship [15,16,20]. Thus, counseling on continued condom use for HIV prevention with the delivery of PrEP may be a missed opportunity to help HIV serodiscordant couples re-establish intimacy in their relationship.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, these couples reported that condom use works against re-establishing intimacy and closeness, further elongating their emotional distance [15,16,18]. Second, many couples report the desire for children and PrEP provides an opportunity to practice safer conception to minimize transmission risk between them [15,17,19,20]. There is also evidence, however, that following PrEP initiation sexual behaviors associated with HIV risk may not change within HIV serodiscordant couples for reasons including inconsistent PrEP adherence-patterns that are often established early after initiation [5,21], lack of trust in the protective effects of PrEP for HIV prevention [16], and complex partner dynamics surrounding the negotiation of sex and condom use [20,22].…”

Section: Introductionmentioning

confidence: 98%

“…The literature suggests that heterosexual HIV serodiscordant couples have strong incentives for increasing sexual behaviors associated with HIV risk following PrEP initiation [15][16][17][18][19][20]. First, serodiscordant couples have reported that knowledge of serodiscordance alienates them because they fear HIV transmission via condomless sex.…”

Section: Introductionmentioning

confidence: 99%

“…First, serodiscordant couples have reported that knowledge of serodiscordance alienates them because they fear HIV transmission via condomless sex. Additionally, these couples reported that condom use works against re-establishing intimacy and closeness, further elongating their emotional distance [15,16,18]. Second, many couples report the desire for children and PrEP provides an opportunity to practice safer conception to minimize transmission risk between them [15,17,19,20].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

No Evidence of Sexual Risk Compensation Following PrEP Initiation Among Heterosexual HIV Serodiscordant Couples in Kenya and Uganda

et al. 2019

View full text Add to dashboard Cite

Recent studies among men who have sex with men suggest that sexual behaviors associated with risk of sexually transmitted infections increase following initiation of pre-exposure prophylaxis (PrEP) for HIV prevention. We used longitudinal data from HIV-uninfected participants (n = 1013) enrolled in an open-label study of PrEP delivered to Ugandan and Kenyan heterosexual HIV serodiscordant couples to understand the association between PrEP initiation and HIV risk-related sexual behaviors among these couples. In the month following PrEP initiation, the mean number of monthly sex acts within couples decreased from 7.9 to 6.9 (mean difference: − 1.1; 95% CI − 1.5, − 0.7) and the proportion of couples having condomless sex decreased from 65% to 32% (percentage point change: − 33%; 95% CI − 37%, − 30%); these behaviors then remained relatively constant over 2 years. We found no evidence of sexual risk compensation following PrEP initiation within African serodiscordant couples. However, roughly a third of couples continued to engage in condomless sex during follow up, emphasizing the importance of continued PrEP use to sustain HIV protection.

show abstract

HIV self‐testing and oral pre‐exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction: HIV self-testing (HIVST) and oral pre-exposure prophylaxis (PrEP) are complementary, evidence-based, selfcontrolled HIV prevention tools that may be particularly appealing to sex workers. Understanding how HIVST and PrEP are perceived and used by sex workers and their intimate partners could inform prevention delivery for this population. We conducted qualitative interviews to examine ways in which HIVST and PrEP use influence prevention choices among sex workers in Uganda. Methods: Within a randomized trial of HIVST and PrEP among 110 HIV-negative cisgender women, cisgender men and transgender women sex workers (NCT03426670), we conducted 40 qualitative interviews with 30 sex workers and 10 intimate partners (June 2018 to January 2020). Sex worker interviews explored (a) experiences of using HIVST kits; (b) how HIVST was performed with sexual partners; (c) impact of HIVST on PrEP pill taking; and (d) sexual risk behaviours after HIVST. Partner interviews covered (i) introduction of HIVST; (ii) experiences of using HIVST; (iii) HIV status disclosure; and (iv) HIVST's effect on sexual behaviours. Data were analysed using an inductive content analytic approach centering on descriptive category development. Together, these categories detail the meaning of HIVST and PrEP for these qualitative participants. Results: Using HIVST and PrEP was empowering for this group of sex workers and their partners. Three types of empowerment were observed: (a) economic; (b) relational; and (c) sexual health. (i) Using HIVST and PrEP made sex without condoms safer. Sex workers could charge more for condomless sex, which was empowering economically. (ii) Self-testing restored trust in partners' fidelity upon being reunited after a separation. This trust, in combination with condomless sex made possible by PrEP use, restored intimacy, empowering partnered relationships. (iii) HIVST and PrEP enabled sex workers to take control of their HIV prevention efforts and avoid the stigma of public clinic visits. In this way they were empowered to protect their sexual health. Conclusions: In this sample, sex workers' use of HIVST and PrEP benefitted not only prevention efforts, but also economic and relational empowerment. Understanding these larger benefits and communicating them to stakeholders could strengthen uptake and use of combination prevention interventions in this marginalized population.

show abstract

Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples

Cited by 37 publications

References 31 publications

Inconsistent condom use between serodifferent sexual partnerships to the human immunodeficiency virus

Inconsistent condom use between serodifferent sexual partnerships to the human immunodeficiency virus

No Evidence of Sexual Risk Compensation Following PrEP Initiation Among Heterosexual HIV Serodiscordant Couples in Kenya and Uganda

HIV self‐testing and oral pre‐exposure prophylaxis are empowering for sex workers and their intimate partners: a qualitative study in Uganda

Contact Info

Product

Resources

About