Bjertrup Pia Juul, Mmema Nqobile, Dlamini Velibanti, Ciglenecki Iza, Mpala Qhubekani, Matse Sindy, Kerschberger Bernhard, Wringe Alison
Médecins Sans Frontières, Mbabane, Eswatini.
Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark.
BMC Public Health. 2021 Apr 14;21(1):727. doi: 10.1186/s12889-021-10766-0.
Pre-exposure-prophylaxis (PrEP) has been heralded for its potential to put women in control of preventing HIV infection, but uptake and continuation rates have been disappointing in high-incidence settings in sub-Saharan Africa. We explored structural and social factors that influenced PrEP use among young women and pregnant or breastfeeding women in rural Eswatini.
We conducted two in-depth interviews with ten women on PrEP, and one-time in-depth interviews with fourteen women who declined or discontinued PrEP. Interviews covered decision-making processes around PrEP initiation and experiences with pill-taking. In-depth interviews were conducted with nine health workers, covering experiences in delivering PrEP services, and two focus group discussions were held with men to elicit their perceptions of PrEP. Interviews and discussions were audio-recorded, translated, transcribed and analysed thematically, using an inductive approach.
PrEP initiation and use were experienced by many women as empowering them to take control of their health and well-being, and stay HIV free, facilitating them to realise their aspirations relating to motherhood and educational attainment. However, the social norms that defined relationship dynamics with partners or family members either undermined or promoted this empowerment potential. In particular, young women were rarely supported by family members to take PrEP unless it was perceived to be for protecting an unborn child. Stigmatisation of pill-taking through its associations with HIV and the burden of daily pill-taking also contributed to PrEP discontinuation.
Unlike many prevention tools, PrEP enabled women to achieve a sense of control over their lives. Nevertheless, women's agency to continue and adhere to PrEP was influenced by social and structural factors including gender norms, family expectations of young women, relationship dynamics and stigma related to HIV. Future interventions should address these barriers to promote PrEP use among sexually-active women.
暴露前预防（PrEP）因其有望让女性掌控预防艾滋病毒感染而备受赞誉，但在撒哈拉以南非洲的高发病率地区，其采用率和持续使用率一直不尽人意。我们探究了影响斯威士兰农村年轻女性以及怀孕或哺乳期女性使用PrEP的结构和社会因素。
我们对10名使用PrEP的女性进行了两次深入访谈，对14名拒绝或停止使用PrEP的女性进行了一次性深入访谈。访谈涵盖了开始使用PrEP的决策过程以及服药体验。对9名卫生工作者进行了深入访谈，涵盖了提供PrEP服务的经历，并与男性进行了两次焦点小组讨论，以了解他们对PrEP的看法。访谈和讨论进行了录音、翻译、转录，并采用归纳法进行主题分析。
许多女性认为开始使用和使用PrEP使她们能够掌控自己的健康和幸福，并保持艾滋病毒阴性，有助于她们实现与母亲身份和教育成就相关的愿望。然而，定义与伴侣或家庭成员关系动态的社会规范要么削弱要么促进了这种赋权潜力。特别是，年轻女性很少得到家庭成员的支持来服用PrEP，除非认为这是为了保护未出生的孩子。因与艾滋病毒相关联而对服药产生的污名化以及每日服药的负担也导致了PrEP的停用。
与许多预防工具不同，PrEP使女性能够获得对自己生活的掌控感。然而，女性继续并坚持使用PrEP的能力受到社会和结构因素的影响，包括性别规范、家庭对年轻女性的期望、关系动态以及与艾滋病毒相关的污名。未来的干预措施应解决这些障碍，以促进性活跃女性使用PrEP。
