Re-focusing HIV prevention messages: a qualitative study in rural Uganda

Mathur, Sanyukta; Romo, Dina L.; Rasmussen, Mariko; Nakyanjo, Neema; Nalugoda, Fred; Santelli, John

doi:10.1186/s12981-016-0123-x

Cited by 4 publications

(2 citation statements)

References 30 publications

(18 reference statements)

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“…Additionally, in most cases, the ways in which men described testing suggested that it served to validate their continuation of current sexual relationship practices rather than prompting a reconsideration of these practices. This finding is in line with other recent research in Uganda suggesting that while women adhered to public health messages promoting faithfulness as a means of HIV risk reduction, this was not the case with men [ 32 ]. Rather than only sending clients who test negative on their way with a recommendation to retest and use condoms, testing and counseling strategies should support men to reduce risk and build healthier relationships [ 33 ].…”

Section: Discussionsupporting

confidence: 91%

Male partners of young women in Uganda: Understanding their relationships and use of HIV testing

Gottert¹,

Pulerwitz²,

Siu³

et al. 2018

PLoS ONE

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BackgroundSubstantial concern exists about the high risk of sexually transmitted HIV to adolescent girls and young women (AGYW, ages 15–24) in Eastern and Southern Africa. Yet limited research has been conducted with AGYW’s male sexual partners regarding their perspectives on relationships and strategies for mitigating HIV risk. We sought to fill this gap in order to inform the DREAMS Partnership and similar HIV prevention programs in Uganda.MethodsWe conducted 94 in-depth interviews, from April-June 2017, with male partners of AGYW in three districts: Gulu, Mukono, and Sembabule. Men were recruited at community venues identified as potential transmission areas, and via female partners enrolled in DREAMS. Analyses focused on men’s current and recent partnerships and HIV service use.ResultsMost respondents (80%) were married and 28 years old on average. Men saw partner concurrency as pervasive, and half described their own current multiple partners. Having married in their early 20s, over time most men continued to seek out AGYW as new partners, regardless of their own age. Relationships were highly fluid, with casual short-term partnerships becoming more formalized, and more formalized partnerships characterized by periods of separation and outside partnerships. Nearly all men reported recent HIV testing and described testing at distinct relationship points (e.g., when deciding to continue a relationship/get married, or when reuniting with a partner after a separation). Testing often stemmed from distrust of partner behavior, and an HIV-negative status served to validate respondents’ current relationship practices.ConclusionsAcross the three regions in Uganda, findings with partners of AGYW confirm earlier reports in Uganda of multiple concurrent partnerships, and demonstrate substantial HIV testing. Yet they also unearth the degree to which these partnerships are fluid (switching between casual and/or more long-term partnerships), which complicates potential HIV prevention strategies. Context-specific findings around these partnerships and risk are critical to further tailor HIV prevention programs.

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Section: Discussionsupporting

confidence: 91%

Male partners of young women in Uganda: Understanding their relationships and use of HIV testing

Gottert¹,

Pulerwitz²,

Siu³

et al. 2018

PLoS ONE

Self Cite

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“…This “bifurcation” of risk and pleasure in public discourse about sex continues to shape how most young people learn about sex and romance. For instance, one recent study of young Rakai residents’ responses to HIV prevention messaging found that they overwhelmingly perceive sex to be dangerous because of its association with HIV ( Mathur et al, 2016 ). Earmarking funds for abstinence programming also affects the availability of condoms, anti-retroviral therapy, and other SRH technologies, the wholesale costs of which are offset by government subsidies, as well as the willingness of providers to distribute them to young, unmarried men and women, as we discuss below.…”

Section: Introductionmentioning

confidence: 99%

“Sex is supposed to be naturally more pleasurable”: Healers as providers of holistic sexual and reproductive healthcare in Uganda

Moore

Ddaaki

Hirsch

et al. 2022

Social Science & Medicine

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Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study

et al. 2020

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Few studies have sought to understand factors influencing uptake and continuation of pre-exposure prophylaxis (PrEP) among young adults in sub-Saharan Africa in the context of population-based delivery of open-label PrEP. To address this gap, this qualitative study was implemented within the SEARCH study (NCT#01864603) in Kenya and Uganda, which achieved near-universal HIV testing, and offered PrEP in 16 intervention communities beginning in 2016-2017. Focus group discussions (8 groups, n = 88 participants) and in-depth interviews (n = 23) with young adults who initiated or declined PrEP were conducted in five communities, to explore PrEP-related beliefs and attitudes, HIV risk perceptions, motivations for uptake and continuation, and experiences. Grounded theoretical methods were used to analyze data. Young people felt personally vulnerable to HIV, but perceived the severity of HIV to be low, due to the success of antiretroviral therapy (ART): daily pilltaking was more threatening than the disease itself. Motivations for PrEP were highly gendered: young men viewed PrEP as a vehicle for safely pursuing multiple partners, while young women saw PrEP as a means to control risks in the context of engagement in transactional sex and limited agency to negotiate condom use and partner testing. Rumors, HIV/ART-related stigma, and desire for "proof" of efficacy militated against uptake, and many women required partners' permission to take PrEP. Uptake was motivated by high perceived HIV risk, and beliefs that PrEP use supported life goals. PrEP was often discontinued due to dissolution of partnerships/changing risk, unsupportive partners/peers, or early side effects/pill burden. Despite high perceived risks and interest, PrEP was received with moral ambivalence because of its associations with HIV/ ART and stigmatized behaviors. Delivery models that promote youth access, frame messaging on wellness and goals, and foster partner and peer support, may facilitate uptake among young people.

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Re-focusing HIV prevention messages: a qualitative study in rural Uganda

Cited by 4 publications

References 30 publications

Male partners of young women in Uganda: Understanding their relationships and use of HIV testing

Male partners of young women in Uganda: Understanding their relationships and use of HIV testing

“Sex is supposed to be naturally more pleasurable”: Healers as providers of holistic sexual and reproductive healthcare in Uganda

Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study

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