Motivations for Reducing Other HIV Risk-Reduction Practices if Taking Pre-Exposure Prophylaxis: Findings from a Qualitative Study Among Women in Kenya and South Africa

Abstract

Findings from a survey conducted among women at high risk for HIV in Bondo, Kenya, and Pretoria, South Africa, demonstrated that a substantial proportion would be inclined to reduce their use of other HIV riskreduction practices if they were taking pre-exposure prophylaxis (PrEP). To explore the motivations for their anticipated behavior change, we conducted qualitative interviews with 60 women whose survey responses suggested they would be more likely to reduce condom use or have sex with a new partner if they were taking PrEP compared to if they were not taking PrEP. Three interrelated themes were identified: (1) ''PrEP protects''-PrEP was perceived as an effective HIV prevention method that replaced the need for condoms; (2) condoms were a source of conflict in relationships, and PrEP would provide an opportunity to resolve or avoid this conflict; and (3) having sex without a condom or having sex with a new partner was necessary for receiving material goods and financial assistance-PrEP would provide reassurance in these situations. Many believed that PrEP alone would be a sufficient HIV risk-reduction strategy. These findings suggest that participants' HIV risk-reduction intentions, if they were to use PrEP, were based predominately on their understanding of the high efficacy of PrEP and their experiences with the limitations of condoms. Enhanced counseling is needed to promote informed decision making and to ensure overall sexual health for women using PrEP for HIV prevention, particularly with respect to the prevention of pregnancy and other sexually transmitted infections when PrEP is used alone.

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

“…Very few studies reported clear opposition to PrEP as an HIV prevention tool, although some generated evidence of community distrust of study/trial designs or of the concept of PrEP itself [21]. Theoretical studies among potential end-users typically found high acceptability of PrEP [22][23][24][25][26][27][28][29][30][31]. By including the theoretical research, a range of regimens are included in the review including: oral daily and intermittent (the definition of which is particular to the given study), as well as emerging injectable and vaginal ring products.…”

“…Even within marriage and during pregnancy, women worried partners might “bring HIV into the home” . Many women only acknowledged risk of HIV infection within their primary relationship but fear of rape and other violence was also cited as a motivator for PrEP use .…”

“…In their study of PrEP adherence influencing factors as part of FEM‐PrEP, Corneli et al . reported some male partners of female participants were very supportive and would remind them to take the pills . Some had partners who merely acquiesced to their pill use, while a few opted not to tell their partners at all for fears of negative reaction and insistence of cessation.…”

When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling

“…The primary purpose of the follow-up interviews was to explore women's motivations for reducing the use of other HIV risk-reduction practices if they were to take PrEP (Corneli, Namey, et al 2015). We also wanted to understand the context of these women's sexual lives and decision-making as it related to starting and stopping PrEP, so that their experiences and motivations might inform counselling around PrEP discontinuation.…”

Guidance for Providing Informed-Choice Counseling on Sexual Health for Women Interested in Pre-Exposure Prophylaxis in Kenya and South Africa

“…Many also believed that PrEP alone would be a sufficient HIV risk-reduction strategy. 5 These results highlighted the necessity of having guidance that encourages informed decision-making by providing essential HIV prevention information within the context of PrEP while helping women to reflect upon the information within their own values and risk situations and apply the information to their individual needs and circumstances.…”