Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450, Oslo, Norway.
Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
Soc Sci Med. 2024 Oct;358:117245. doi: 10.1016/j.socscimed.2024.117245. Epub 2024 Aug 17.
Pre-exposure prophylaxis (PrEP) is a drug with the power to prevent HIV transmission. This study delved into the broader implications of PrEP use among female sex workers in Dar es Salaam, Tanzania, a group disproportionately affected by HIV and socio-structural challenges. Through 46 in-depth interviews with 40 women who were either former or current PrEP users or intended to start PrEP between January 2021 and February 2022, we sought to explore the nuanced effects of PrEP. Inspired by Whyte et al. and "Social Life of Medicines", we asked what PrEP could do in the lives of female sex workers and analyzed the data using reflexive thematic analysis and an interpretative phenomenological approach. We found that PrEP had multiple and diverse effects in many domains of women's lives and refer to these collectively as the "effectosphere" of PrEP. The study identifies four key themes that jointly describe this effectosphere: (1) PrEP could promote human flourishing and empowerment by facilitating a feeling of freedom and confidence which could promote health, social relations, and economic and work opportunities, (2) PrEP could inflict harm (and fears of such harms), partially reflecting medical mistrust rooted in an understanding that sex workers were undesired in society, (3) PrEP could expose sensitive information about its users that could lead to stigma, arguments and needs for elaborate explanations, and (4) PrEP could medicalize daily life, evidenced through daily pill taking, clinical appointments, side-effects, becoming reliant on the medication, and the challenges of integrating PrEP use with other life priorities. We argue that investigating the full effectosphere of any medicine in particular geographic and sociocultural contexts can lead to a better understanding of its use and non-use, highlighting that engaging with medication extends beyond just "taking a pill."
暴露前预防（PrEP）是一种具有预防 HIV 传播能力的药物。本研究深入探讨了坦桑尼亚达累斯萨拉姆的性工作者群体中 PrEP 使用的更广泛影响，该群体受到 HIV 和社会结构挑战的不成比例影响。通过 2021 年 1 月至 2022 年 2 月期间对 40 名曾使用或正在使用 PrEP 或打算开始使用 PrEP 的女性进行的 46 次深入访谈，我们试图探索 PrEP 的细微影响。受 Whyte 等人和“社会生活中的药物”的启发，我们询问 PrEP 在性工作者生活中能做什么，并使用反思性主题分析和解释性现象学方法分析数据。我们发现，PrEP 在女性生活的许多领域产生了多种不同的影响，我们将这些影响统称为 PrEP 的“影响圈”。该研究确定了四个共同描述该影响圈的关键主题：(1) PrEP 通过促进自由和自信的感觉，可以促进健康、社会关系以及经济和工作机会，从而促进人类繁荣和赋权；(2) PrEP 可能会造成伤害（以及对这种伤害的恐惧），部分反映了根植于社会认为性工作者不受欢迎的医学不信任；(3) PrEP 可能会暴露其使用者的敏感信息，从而导致污名、争论和对详细解释的需求；(4) PrEP 可以将日常生活医学化，表现在每天服用药丸、预约看诊、出现副作用、对药物产生依赖以及将 PrEP 使用与其他生活重点结合的挑战。我们认为，在特定的地理和社会文化背景下研究任何药物的完整影响圈，可以更好地理解其使用和不使用情况，这表明与药物的接触不仅仅是“服用一片药”。
