Gendered differences in the perceived risks and benefits of oral PrEP among HIV-serodiscordant couples in Kenya

Abstract

Pre-exposure prophylaxis (PrEP) is effective for preventing HIV among HIV serodiscordant heterosexual couples. Gender roles may influence perceived personal and social risks related to HIV prevention behaviors and may affect use of PrEP. In this study, interviews and focus groups were conducted with 68 individuals from 34 mutually disclosed serodiscordant heterosexual partnerships in Thika, Kenya. Socio-cultural factors that affect adherence to PrEP were explored using grounded analysis. Three factors were identified, which shape perceptions of PrEP: gendered power dynamics and control over decision-making in the household; conflicts between risk reduction strategies and male sexual desire; culture bound definitions of women’s work. Adherence to PrEP in the Partners PrEP Study was high; however, participants articulated conflicting interests related to PrEP in connection with traditional gender roles. The successful delivery of PrEP will require understanding of key social factors, particularly related to gender and dyadic dynamics around HIV serostatus.

Understanding user perspectives of and preferences for oral PrEPforHIVprevention in the context of intervention scale‐up: a synthesis of evidence from sub‐Saharan Africa

“…Carroll et al . examined gender dynamics within relationships and how these influence decision making relating to PrEP, identifying a wide variety of experiences . HIV‐negative women in their study overwhelmingly reported that the decision for either partner to initiate ART or PrEP, as appropriate, belonged entirely to their husbands.…”

What motivates serodiscordant couples to prevent HIV transmission within their relationships: findings from a PrEP implementation study in Kenya

“…Although both women and men engage in agricultural production in western Kenya, for example, women are largely responsible for lesser-earning subsistence farming (African Development Bank 2007; Dalsgaard et al 2016). Indeed, 68% of the currently married women in western Kenya earn less money from paid work than their husbands (Kenya Ministry of Health and National Bureau of Statistics 2015) and are expected to perform unpaid work including childcare and cooking (African Development Bank 2007; Carroll et al 2016). …”

“…Specifically, participants reported the need for women to use ART to prevent HIV transmission to the HIV-uninfected male partner so he could continue to provide financially for the family and care for the children. Others have documented how the sexual division of labour influences the uptake of biomedical HIV prevention strategies among serodiscordant couples (Carroll et al 2016; Fowler et al 2015). For example, men’s fear of side effects from PrEP, particularly influencing their ability to work and provide for their family, prevented them from accepting PrEP (Fowler et al 2015).…”

‘If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV’: HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda

“…Even then, this study did not document men’s reactions to receiving kits from their female partners. Given the gender imbalance between men and women particularly in sub-Saharan African countries – where men take the upper hand and control decision-making processes in the home [12] – the idea of using women to introduce HIVST kits to male partners can have adverse consequences for the women. This is particularly the case when such women deliver the kits without seeking the male partner’s consent first.…”