Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of the International AIDS Society
Abstract
Pre-exposure prophylaxis (PrEP) to prevent HIV infection is being rolled out in Africa. The uptake of PrEP to date
has varied across populations and locations. We seek to understand the drivers of demand for PrEP through analysis of qualitative
data collected in conjunction with a PrEP demonstration project involving East African HIV serodiscordant couples. Our
goal was to inform demand creation by understanding what PrEP means – beyond HIV prevention – for the lives of users.
Methods: The Partners Demonstration Project evaluated an integrated strategy of PrEP and antiretroviral therapy (ART) delivery
in which time-limited PrEP served as a “bridge” to long-term ART. Uninfected partners in HIV serodiscordant couples
were offered PrEP at baseline and encouraged to discontinue once infected partners had taken ART for six months. We conducted
274 open-ended interviews with 93 couples at two Ugandan research sites. Interviews took place one month after
enrolment and at later points in the follow-up period. Topics included are as follows: (1) discovery of serodiscordance; (2) decisions
to accept/decline PrEP and/or ART; (3) PrEP and ART initiation; (4) experiences of using PrEP and ART; (5) PrEP discontinuation;
(6) impact of PrEP and ART on the partnered relationship. Interviews were audio-recorded and transcribed. We
used an inductive, content analytic approach to characterize meanings of PrEP stemming from its effectiveness for HIV prevention.
Relevant content was represented as descriptive categories.
Results: Discovery of HIV serodiscordance resulted in fear of HIV transmission for couples, which led to loss of sexual intimacy
in committed relationships, and to abandonment of plans for children. As a result, partners became alienated from each
other. PrEP countered the threat to the relationship by reducing fear and reinstating hopes of having children together. Condom
use worked against the re-establishment of intimacy and closeness. By increasing couples’ sense of protection against
HIV infection and raising the prospect of a return to “live sex” (sex without condoms), PrEP was perceived by couples as solving
the problem of serodiscordance and preserving committed relationships.
Conclusions: The most effective demand creation strategies for PrEP may be those that address the everyday life priorities
of potential users in addition to HIV prevention.
Description
Keywords
Prevention, PrEP, HIV, Serodiscordant couples, Demand creation
Citation
Nakku‐Joloba, E., Pisarski, E. E., Wyatt, M. A., Muwonge, T. R., Asiimwe, S., Celum, C. L., ... & Ware, N. C. (2019). Beyond HIV prevention: Everyday life priorities and demand for Pr EP among Ugandan HIV serodiscordant couples. Journal of the International AIDS Society, 22(1), e25225. https://doi.org/10.1002/jia2.25225