title: 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 sociocultural 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 sociocultural 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.
authors.affiliation: a Women's Global Health Imperative, RTI International , San Francisco , USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: a Women's Global Health Imperative, RTI International , San Francisco , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Montgomery
authors.affiliation: b Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Stadler
authors.affiliation: a Women's Global Health Imperative, RTI International , San Francisco , USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Laborde
authors.affiliation: b Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Busisiwe
authors.initials: B
authors.lastname: Magazi
authors.affiliation: b Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa.
authors.forename: Florence
authors.initials: F
authors.lastname: Mathebula
authors.affiliation: a Women's Global Health Imperative, RTI International , San Francisco , USA.|c Center for AIDS Prevention Studies, Department of Medicine , University of California , San Francisco , USA.
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D017008:Negotiating; D065129:Pre-Exposure Prophylaxis; D036301:Qualitative Research; D011902:Rape; D012742:Sex Offenses; D012747:Sexual Partners; D013019:South Africa; D014930:Women; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Gender; HIV prevention; South Africa; female-initiated methods; pre-exposure prophylaxis; sexual violence