title: 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 risk-reduction 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.
authors.affiliation: 1 Social and Behavioral Health Sciences , FHI 360, Durham, North Carolina.
authors.forename: Amy
authors.initials: A
authors.lastname: Corneli
authors.affiliation: 1 Social and Behavioral Health Sciences , FHI 360, Durham, North Carolina.
authors.forename: Emily
authors.initials: E
authors.lastname: Namey
authors.affiliation: 3 Setshaba Research Centre , Pretoria, South Africa .
authors.forename: Khatija
authors.initials: K
authors.lastname: Ahmed
authors.affiliation: 2 Impact Research and Development Organization , Kisumu, Kenya .
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.affiliation: 3 Setshaba Research Centre , Pretoria, South Africa .
authors.forename: Joseph
authors.initials: J
authors.lastname: Skhosana
authors.affiliation: 2 Impact Research and Development Organization , Kisumu, Kenya .
authors.forename: Jacob
authors.initials: J
authors.lastname: Odhiambo
authors.affiliation: 1 Social and Behavioral Health Sciences , FHI 360, Durham, North Carolina.
authors.forename: Greg
authors.initials: G
authors.lastname: Guest
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D009042:Motivation; D010342:Patient Acceptance of Health Care; D065129:Pre-Exposure Prophylaxis; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D012959:Socioeconomic Factors; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents