Ngure Kenneth, Thuo Nicholas, Ogello Vallery, Kiptinness Catherine, Kamolloh Kevin, Burns Bridget Frances O'Rourke, Mugo Nelly R, Bukusi Elizabeth A, Garrison Lindsey, Baeten Jared M, Haberer Jessica E
Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
Department of Global Health, University of Washington, Seattle, WA, United States.
Front Reprod Health. 2021 Aug 12;3:637869. doi: 10.3389/frph.2021.637869. eCollection 2021.
In Kenya and elsewhere in sub-Saharan Africa, young women are disproportionately affected by the HIV epidemic compared to young men. The extent to which young women's self-perceptions about risk of HIV acquisition influence their sexual behaviors and use of HIV prevention methods remains unclear. We therefore conducted a qualitative study to explore these issues among young women enrolled in a pre-exposure prophylaxis (PrEP) trial. From January 2017 to January 2020, we conducted serial semi-structured in-depth interviews 50 purposively selected young women (18-24 years old) who were participating in the MPYA (Monitoring PrEP for Young Adult women) study-a randomized controlled trial in Thika and Kisumu, Kenya, assessing the impact of SMS reminders on PrEP adherence. Interviews were conducted at three time points (~1 week, 3, and 12 months after initiating PrEP). We used an inductive, content analytic approach to identify key themes related to risk perceptions, sexual behavior, and use of HIV prevention tools. Around the time of enrollment, most of the 50 women interviewed reported being at high risk of HIV because of their own sexual behaviors, such as inconsistent condom use, multiple sexual partners, and transactional sex. Additionally, high risk perception was based on the behavior of their partners, such as refusing to use condoms and being unsure of their partner's HIV status. Young women's perceived risk of HIV acquisition was a key motivator for PrEP initiation and continuation. During PrEP use, participants reported feeling protected and at less risk compared to peers who were not taking PrEP. Some reported no longer using condoms because they were confident that PrEP provided enough protection. Over time, many young women reported reducing risky sexual behaviors because of the regular counseling and HIV testing they received as part of their PrEP services. This lowered risk perception was in most cases accompanied by discontinuation of PrEP. HIV risk perception among young women in Kenya was dynamic and influenced their use of PrEP and condoms over time, suggesting an often-deliberate approach to HIV prevention and sexual health.
在肯尼亚及撒哈拉以南非洲的其他地区，与年轻男性相比，年轻女性受艾滋病毒疫情的影响尤为严重。年轻女性对感染艾滋病毒风险的自我认知在多大程度上影响她们的性行为及艾滋病毒预防方法的使用尚不清楚。因此，我们开展了一项定性研究，以探讨参与暴露前预防（PrEP）试验的年轻女性中的这些问题。2017年1月至2020年1月，我们对50名经过有目的选择的年轻女性（18至24岁）进行了系列半结构化深度访谈，她们参与了MPYA（监测年轻成年女性的PrEP）研究——肯尼亚锡卡和基苏木的一项随机对照试验，评估短信提醒对PrEP依从性的影响。访谈在三个时间点进行（开始PrEP后约1周、3个月和12个月）。我们采用归纳式内容分析方法来确定与风险认知、性行为及艾滋病毒预防工具使用相关的关键主题。在入组前后，接受访谈的50名女性中大多数报告称，由于自身的性行为，如不坚持使用避孕套、有多个性伴侣及性交易，她们感染艾滋病毒的风险很高。此外，高风险认知还基于其伴侣的行为，如拒绝使用避孕套及不确定伴侣的艾滋病毒感染状况。年轻女性感知到的感染艾滋病毒风险是开始及持续使用PrEP的关键动力。在使用PrEP期间，与未服用PrEP的同龄人相比，参与者报告感觉受到了保护且风险降低。一些人报告不再使用避孕套，因为他们相信PrEP提供了足够的保护。随着时间的推移，许多年轻女性报告称，由于她们作为PrEP服务一部分所接受的定期咨询和艾滋病毒检测，她们减少了危险的性行为。这种风险认知的降低在大多数情况下伴随着PrEP的停用。肯尼亚年轻女性中的艾滋病毒风险认知是动态变化的，且随着时间的推移影响了她们对PrEP和避孕套的使用，这表明在艾滋病毒预防和性健康方面往往采取了深思熟虑的方法。
