Académique Documents
Professionnel Documents
Culture Documents
Gendered differences in the perceived risks and benets of oral PrEP among HIVserodiscordant couples in Kenya
Jennifer J. Carrolla,b, Kenneth Ngurec,e, Renee Heffrona,c, Kathryn Currana, Nelly R. Mugof and Jared M. Baetena,c,d
Department of Epidemiology, University of Washington, Seattle, Washington, USA; bDepartment of Anthropology, University of Washington,
Seattle, Washington, USA; cDepartment of Global Health, University of Washington, Seattle, Washington, USA; dDepartment of Medicine,
University of Washington, Seattle, Washington, USA; eJomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; fKenya Medical
Research Institute, Nairobi, Kenya
ABSTRACT
ARTICLE HISTORY
Introduction
By 2012, approximately 1.2 million people in Kenya
between 15 and 64 years of age were living with HIV,
and an estimated 4.8% of cohabitating married couples
were in serodiscordant partnerships, placing nearly
260,000 seronegative spouses at risk for new HIV infection (Maina et al., 2014). Recent studies demonstrate that
novel biomedical prevention interventions can result in
substantial reductions in the risk of HIV transmission
between serodiscordant heterosexual partners through
early initiation of antiretroviral therapy (ART) for the
seropositive partner (Cohen et al., 2011) and preexposure prophylaxis (PrEP) for the seronegative partner
(Baeten et al., 2012; Grant et al., 2010).
Social science research has demonstrated that culturally constructed gender roles and dynamics can inuence the adoption of HIV risk-reduction behaviors
promoted by various HIV-prevention interventions
(Bourgois, Prince, & Moss, 2004; Montgomery et al.,
2008; Montgomery, Chidanyika, Chipato, & van der
Straten, 2012; Wagner, Bloom, Hathazi, Sanders, &
Lankenau, 2013; Woodsong & Alleman, 2008). Both
the seronegative partners belief in treatment efcacy
(Johnson et al., 2011) and socially scripted norms of
masculinity, which incentivize men to do things like
CONTACT Jennifer J. Carroll
2016 Taylor & Francis
jencarr2@uw.edu
KEYWORDS
J. J. CARROLL ET AL.
Methods
This is a qualitative study that explores gendered differences in the perceived risks, benets, and barriers to
using daily oral PrEP in heterosexual, HIV-serodiscordant couples.
Participants in this study were in long-term, HIV-serodiscordant sexual relationships. All were recruited from
among the 496 couples enrolled at the Thika, Kenya, site
for the Partners PrEP Study, a placebo-controlled randomized control trial designed to test the efcacy of
PrEP for HIV prevention in heterosexual men and
women (Baeten et al., 2012). All participants in the Partners PrEP study received HIV testing and HIV-prevention counseling at baseline, as well as counseling on the
nature of placebos and a clear description that the efcacy of PrEP as a prevention mechanism had not been
scientically established at that time.
Couples from the Partners PrEP Study were included
into this qualitative sub-study if they were in a stable,
sexually active, relationship; if both spouses were at
least 18 years old; and if the seropositive partner had
not yet initiated ART. Couples who were known to
have experienced incident HIV infection after enrollment into the Partners PrEP Study (i.e., couples in
which the seronegative partner had become infected)
were not included in this study. The serostatus of all
couples participating in the Partners PrEP Study was
mutually disclosed. For this qualitative sub-study, a convenience sample was generated by contacting eligible
couples by phone. Those willing and available to participate were invited to the site for either for focus group discussions (FGDs) or for individual interviews (IDIs). IDI
participants were recruited as a couple; FGD participants
were recruited individually.
A total of eight FGDs were conducted: two with only
HIV-seropositive women, two with only seropositive
men, two with only seronegative women, and two with
only seronegative men. Twenty IDIs were conducted,
during which each individual was interviewed alone,
without their study partner present. IDIs and FGDs
were led by a social science team, which consisted of a
trained interviewer and an assistant for taking notes.
The interviewer used a guide, which focused on participants experiences participating in the Partners PrEP
Study, acquiring PrEP, and using PrEP, as well as their
preferences for accessing PrEP or ART following the
end of the trial. Guides were specic to the interview
Results
A sample of 68 participants in the Partners PrEP Study
participated in this research (see Table 1). Of these, 33
were HIV seropositive (18 women, 15 men) with an
average age of 35.2 years (range: 2060) and average
CD4 count of 550.9 cells/mm3 (range: 2611164) prior
to recruitment into this sub-study. The remaining 35
participants were HIV seronegative (18 women, 17
men) with an average age of 38.1 years (range: 2263).
Relationship characteristics were available for a majority
of participants. Among them, the average duration of the
relationship was approximately 10 years, and 12% of
male participants reported concurrent relationships
with multiple wives.
Three distinct themes were identied in the FGD and
IDI data: (1) gendered power dynamics and control over
decision-making in the household; (2) conicts between
risk-reduction strategies and male sexual desire; (3) culture-bound denitions of womens work in the household. For clarity, direct quotes have been marked to
AIDS CARE
35 (51.5%)
18 (51.4%)
38.1 (2236)
33 (48.5%)
18 (54.6%)
35.2 (2060)
550.9 (2611164)
8 (712)
3 (12%)
10.0 (3.815)
N
55
26a
55
10.5 (3.216.8)
55
indicate the speaker is a seropositive female (F+), a seropositive male (M+), a seronegative female (F), or a
seronegative male (M).
Downloaded by [72.92.239.185] at 05:24 12 January 2016
J. J. CARROLL ET AL.
Discussion
This is a qualitative study exploring the sociocultural factors that shape heterosexual, HIV-serodiscordant
couples experiences with PrEP for HIV prevention.
Analysis of IDI and FGD transcripts revealed differences
in the reported risks, benets, and value of PrEP among
study participants according to the gender of the participant as well as the gender of the seropositive spouse.
Three major themes were identied among these differences: the gendered power dynamics and control over
medical decision-making; the interference of prevention
strategies with the fulllment of male sexual drives; and
AIDS CARE
J. J. CARROLL ET AL.
Acknowledgements
The content is solely the responsibility of the authors and does
not necessarily represent the ofcial views of the National
Institutes of Health.
Disclosure statement
No potential conict of interest was reported by the authors.
Funding
This work was supported by the National Institutes of Mental
Health and Nursing Research of the US National Institutes of
Health [grants R01 MH095507 and R21 NR012663] and the
Bill and Melinda Gates Foundation [grant OPP47674].
References
Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J.
D., Wangisi, J., Celum, C. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.
New England Journal of Medicine, 367(5), 399410. doi:10.
1056/NEJMoa1108524
Bourgois, P., Prince, B., & Moss, A. (2004). The everyday violence of Hepatitis C among young women who inject drugs
in San Francisco. Human Organization, 63(3), 253264.
Bunnell, R., Nassozi, J., Marum, E., Mubangizi, J., Malamba, S.,
Dillon, B., Mermin, J. (2005). Living with discordance:
knowledge, challenges, and prevention strategies of HIVdiscordant couples in Uganda. AIDS Care, 17(8), 9991012.
AIDS CARE