Intimate Partner Violence and PrEP Acceptability Among Low-Income, Young Black Women: Exploring the Mediating Role of Reproductive Coercion

Abstract

A few studies suggest that women who experience intimate partner violence (IPV) are willing to use pre-exposure prophylaxis (PrEP), but no research has examined mediators of this relationship. The current study used path analysis to examine a phenomenon closely associated with IPV: reproductive coercion or explicit male behaviors to promote pregnancy of a female partner without her knowledge or against her will. Birth control sabotage and pregnancy coercion—two subtypes of reproductive coercion behaviors—were examined as mediators of the relationship between IPV and PrEP acceptability among a cohort of 147 Black women 18 to 25 years of age recruited from community-based organizations in an urban city. IPV experiences were indirectly related to PrEP acceptability through birth control sabotage (indirect effect=0.08; p<0.05), but not to pregnancy coercion. Findings illustrate the importance of identifying and addressing reproductive coercion when assessing whether PrEP is clinically appropriate and a viable option to prevent HIV among women who experience IPV.

Reproductive coercion among women living with HIV

“…The reproductive coercion prevalence we found is consistent with the high end of prior estimates from urban family planning and obstetrics/gynecology settings (13–16%), 16,17 lower than a lifetime estimate from women at-risk for acquiring HIV (31%), 21 and higher than lifetime estimates from a nationally representative sample (8.6%) 33 and recent studies conducted in samples of mixed rural/urban family planning clinics and among female college students (5–8%). 19,20 Our findings are also consistent with the known associations between reproductive coercion and other coercive, controlling behaviors found in the context of relationship abuse, 13,34 with an overall high prevalence of IPV (54%) noted in our sample.…”

“…12,13,15 In the United States, prevalence of reproductive coercion has been explored in samples such as family planning clinics, obstetrics/gynecology clinics, community-based social services, IPV service provider settings (i.e., shelters, hospital-based IPV programs), and college campuses. 16–21 Evidence linking reproductive coercion to unintended pregnancy has been limited but is persuasive. 19,22,23 Prevalence of reproductive coercion has not previously been evaluated among women living with HIV.…”

“You Never Know What Could Happen”: Women’s Perspectives of Pre-Exposure Prophylaxis in the Context of Recent Intimate Partner Violence

“…In 2012, the U.S. Food and Drug Administration approved the dissemination of PrEP, a daily oral medication HIVnegative persons can take to reduce their risk of sexually acquired HIV (U.S. Food and Drug Administration, 2012). PrEP has the potential to be a novel woman-controlled HIV prevention method because, unlike condoms, women are not required to negotiate its use with their sexual partners (Braksmajer, Senn, & McMahon, 2016;Willie, Kershaw, Campbell, & Alexander, 2017a). Although women represent 19% of all new HIV diagnoses in the United States (Centers for Disease Control and Prevention, 2017), only 4.6% of PrEP users are women (Siegler et al, 2018).…”

Examining the Impact of Intimate Partner Violence Type and Timing on Pre-exposure Prophylaxis Awareness, Interest, and Coercion

“…Specifically, both lifetime and past-year IPV experiences need to be examined since assessing only one-time frame can potentially miss potential PrEP candidates. Further, interest in PrEP is an important first step but it may not inform optimal execution of a daily regimen [16]. Women and men who experience IPV may be concerned about their partner’s ability to control their PrEP.…”

“…However, research from this burgeoning literature is mixed. In particular, some studies find that women who experienced IPV are more willing to use PrEP compared to women without these experiences [14–16]. While other studies found that women with a history of IPV are less likely to be interested and willing to use PrEP [17].…”