Changes in relationships, HIV risk, and feelings towards PrEP: findings from a qualitative explanatory study among participants in the CHARISMA intervention trial
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Published:2023-08-22
Issue:1
Volume:23
Page:
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ISSN:1472-6874
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Container-title:BMC Women's Health
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language:en
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Short-container-title:BMC Women's Health
Author:
Hartmann Miriam,Triplett Noah,Roberts Sarah T.,Lanham Michele,Reddy Krishnaveni,Tenza Siyanda,Mayisela Nonkululeko,Mbewe Dorica,Maboa Ontathile,Mampuru Lydia,Tolley Elizabeth E.,Palanee-Phillips Thesla,Montgomery Elizabeth T.
Abstract
Abstract
Background
Intimate partner violence (IPV) and other relationship-based challenges have been demonstrated to reduce women’s ability to use pre-exposure prophylaxis (PrEP) effectively for HIV prevention. The Community Health Clinical Model for Agency in Relationships and Safer Microbicide Adherence (CHARISMA) intervention was designed to mitigate these challenges and increase South African women’s agency to use PrEP. The CHARISMA randomized controlled trial did not identify statistically significant differences in PrEP adherence or relationship dynamics between the intervention and control arms. As such, the aim of this explanatory qualitative sub-study was to understand women’s experiences with the CHARISMA trial and explore reasons for the null results.
Methods
Twelve CHARISMA trial participants were purposively selected to participate in serial in-depth interviews, which took place at the trial end and 3 months later. Participants represented individuals who had received each of the three counselling modules, 1) healthy communication counselling, 2) PrEP disclosure counselling, or 3) IPV counselling, as well as those in the control arm who received IPV standard-of-care counselling.
Results
A thematic case analysis revealed numerous positive relationship outcomes among intervention participants, including identifying and ending unhealthy relationships, gaining a sense of personal empowerment, and enacting more positive behaviors and HIV risk reduction strategies in subsequent relationships. These positive shifts were occasionally described as contributing to decisions to discontinue PrEP use, which may partly explain the limited impact of the intervention on PrEP adherence.
Conclusions
Future investigations of counselling interventions addressing relationship-based barriers to PrEP use should account for changing risk dynamics and need for PrEP.
Funder
United States Agency for International Development Karolinska Institute
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynecology,Reproductive Medicine,General Medicine
Reference30 articles.
1. Simbayi LC, Zuma K, Zungu N, Moyo S, Marinda E, Jooste S, Mabaso M, Ramlagan S, North A, van Zyl J, Mohlabane N, Dietrich C, Naidoo I and the SABSSM V Team (2019) South African National HIV Prevalence, Incidence, Behaviour and Communication Survey. Cape Town: HSRC Press; 2017. https://hsrc.ac.za/uploads/pageContent/10779/SABSSM%20V.pdf. 2. Irungu EM, Baeten JM. PrEP rollout in Africa: status and opportunity. Nat Med. 2020;26(5):655–64. 3. Strebel A, Crawford M, Shefer T, Cloete A, Dwadwa-Henda N, Kaufman M, et al. Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa. J Soc Aspects of HIV/AIDS. 2006;3(3):516–28. 4. Organization WH. Violence against women prevalence estimates, 2018: global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. Geneva: World Health Organization; 2021. 5. Stockman JK, Lucea MB, Campbell JC. Forced Sexual Initiation, Sexual intimate partner violence and hiv risk in women: a global review of the literature. AIDS Behav. 2013;17(3):832–47.
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