Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
PLoS One. 2021 Mar 5;16(3):e0248307. doi: 10.1371/journal.pone.0248307. eCollection 2021.
There is limited understanding of how social dynamics impact pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW) in generalized HIV-epidemic settings. We examined experiences of oral PrEP use disclosure to various social groups with the goal of identifying supportive relationships that can be leveraged to promote adherence.
We used qualitative methods to explore experiences disclosing PrEP use and the perceived impact of disclosure on adherence among 22 South African AGYW (16-25 years) taking daily oral PrEP. Serial in-depth-interviews (IDIs) were conducted 1-, 3-, and 12-months post-PrEP initiation. Respondents also self-reported their disclosures separately for various social groups and adherence was assessed using intracellular tenofovir-diphosphate levels.
Qualitative respondents had a median age of 20.5 years and reported disclosing their PrEP use to friends (n = 36 total disclosures), partners, siblings, other family members (n = 24 disclosures each), and parents (n = 19 disclosures). IDI data revealed that parents and partners provided the most support to respondents and a lack of support from these groups was most often perceived as negatively affecting PrEP use. AGYW described difficulties explaining PrEP to their mothers, who believed PrEP was HIV treatment or would lead to HIV infection. Disclosure to household members was notably meaningful for AGYW (both positively and negatively). Respondents reported leveraging supportive relationships for pill reminders. For respondents who perceived a household member would be unsupportive, however, non-disclosure was less feasible and PrEP use was often stigmatized. To avoid stigma, several respondents hid or discontinued PrEP.
While supportive relationships may facilitate PrEP use, disclosure can also lead to stigma. Counselors should support AGYW in disclosing to key people in their social networks and provide AGYW with materials that lend credibility to explanations of PrEP. Community education is necessary to alleviate PrEP-related stigma and facilitate disclosure.
在普遍存在 HIV 流行的环境中，对于社会动态如何影响青少年女孩和年轻妇女（AGYW）使用暴露前预防（PrEP）的问题，我们的了解十分有限。我们研究了向不同社会群体公开 PrEP 使用情况的经验，目的是确定可以利用的支持性关系，以促进坚持使用。
我们使用定性方法探讨了在开始每天服用口服 PrEP 1、3 和 12 个月后，22 名南非 AGYW（16-25 岁）公开 PrEP 使用情况的经验，以及他们对公开披露对坚持使用的看法。受访者还分别报告了他们向不同社会群体的公开情况，并且通过细胞内的替诺福韦二磷酸酯水平来评估坚持情况。
定性受访者的平均年龄为 20.5 岁，报告了向朋友（总共 36 次公开）、伴侣、兄弟姐妹、其他家庭成员（每人 24 次）和父母（每人 19 次）公开 PrEP 使用情况。IDI 数据显示，父母和伴侣为受访者提供了最大的支持，而这些群体缺乏支持往往被认为对 PrEP 的使用产生了负面影响。AGYW 表示难以向母亲解释 PrEP，因为母亲认为 PrEP 是 HIV 治疗方法或会导致 HIV 感染。向家庭成员公开 PrEP 使用情况对 AGYW 来说非常重要（无论是积极的还是消极的）。受访者报告说，他们利用支持性关系来提醒他们服用药物。然而，对于那些认为家庭成员不会支持他们的受访者来说，不公开 PrEP 使用情况的可行性较小，并且 PrEP 使用情况经常会受到污名化。为了避免污名化，一些受访者隐瞒或停止使用 PrEP。
虽然支持性关系可能有助于 PrEP 的使用，但公开披露也可能导致污名化。顾问应支持 AGYW 向他们社交网络中的关键人物公开披露，并为 AGYW 提供可信的材料，以解释 PrEP。社区教育对于减轻与 PrEP 相关的污名化和促进公开披露是必要的。
