Negotiating the use of female-initiated HIV prevention methods in a context of gender-based violence: the narrative of rape

Abstract

Female-initiated methods of HIV prevention are needed to address barriers to HIV prevention rooted in gender inequalities. Understanding the socio-cultural context of pre-exposure prophylaxis (PrEP) trials, including gender-based violence, is thus critical. MTN-003C (VOICE-C), a qualitative sub-study of the larger MTN-003 (VOICE) trial, examined socio-cultural barriers and facilitators to PrEP amongst women in Johannesburg. We conducted focus group discussions, in-depth interviews, and ethnographic interviews with 102 trial participants, 22 male partners, 17 community advisory board members, and 23 community stakeholders. We analysed how discussions of rape are emblematic of the gendered context in which HIV risk occurs. Rape emerged spontaneously in half of discussions with community advisory board members, two-thirds with stakeholders and among one-fifth of interviews/discussions with trial participants. Rape was used to reframe HIV risk as external to women’s or partner’s behaviour and to justify the importance of PrEP. Our research illustrates how women, in contexts of high levels of sexual violence, may use existing gender inequalities to negotiate PrEP use. This suggests that future interventions should simultaneously address harmful gender attitudes, as well as equip women with alternative means to negotiate product use, in order to more effectively empower women to protect themselves from HIV.

Forming and implementing community advisory boards in low- and middle-income countries: a scoping review

“…We found 41 included publications provided details on CAB membership and 24 on the process of CAB membership selection. Members were selected through elections by community members [26], purposive sampling selections by the research team, community members, and sometimes stakeholders [13, 18, 23–25, 29–37], or mixed methods combining several of these strategies [16, 24]. A common theme in the descriptions of CAB formation was promoting diversity in CAB membership to ensure adequate representation from key groups.…”

“…One CAB was composed of individuals selected only by chiefs or health care workers [33]. The membership and participation of some women in a South African CAB were limited due to the impact gender-based violence on the selection process [29, 87]. Few CABs used an electoral model to select members, and many CABs lacked a formal structure for participation [5, 33].…”

“…Poor CAB management was discussed as a challenge in fourteen publications [5, 13, 17, 18, 24, 26, 29, 33, 34, 38, 81, 85, 87, 92]. Some researchers were inadequate in providing targeted and appropriate trainings for CAB members [17, 26, 34, 81, 85].…”

“…Most included publications attributed this challenge to the different levels of education and social backgrounds and experience between researchers and members of communities and CABs. Eighteen publications mentioned that community members had better knowledge of local cultural and social contexts compared to researchers [5, 12, 13, 24, 25, 28, 29, 31, 36, 39, 43, 48, 50, 57, 62–64, 84]. Eleven publications also discussed community perceptions of the limitations of researcher-community connections in LMICs related to knowledge gaps and failure to provide enough training in science [13, 16, 17, 24, 31, 33, 35, 40, 85, 88, 95].…”

Acceptability and feasibility of the CHARISMA counseling intervention to support women’s use of pre-exposure prophylaxis: results of a pilot study

“…In practice, however, male partner approval or active support is often desired, required, or culturally indicated for women’s use of these products [ 4 – 6 ], and several studies in southern Africa have found that most study participants (65–87%) disclose their product use to their partners [ 7 – 9 ]. As a result, male partner resistance can pose a significant barrier to the uptake of and adherence to these products [ 7 , 10 – 12 ]. Traditional gender norms that position men as the authority in the household compound the impact of partner resistance on women’s ability to use HIV prevention products [ 13 , 14 ].…”