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确定暴露前预防信息披露的障碍及应对策略:参与性交易的乌干达少女的经历——一项定性研究

Identifying barriers and coping strategies for pre-exposure prophylaxis disclosure: experiences of Ugandan adolescent girls engaged in transactional sex-a qualitative study.

作者信息

Mwima Simon, Bogart Laura M, Neema Steela, Komo Richard, Obbo Stephen

机构信息

Department of Social Work, University of Illinois Urbana Champagne, Champaign, IL, United States.

Bukedi Prevention Institute, Mbale, Uganda.

出版信息

Front Glob Womens Health. 2025 Mar 20;6:1517448. doi: 10.3389/fgwh.2025.1517448. eCollection 2025.


DOI:10.3389/fgwh.2025.1517448
PMID:40182227
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11965671/
Abstract

INTRODUCTION: The disclosure of oral pre-exposure prophylaxis (PrEP) use among adolescent girls engaged in transactional sex in Uganda is a complex process shaped by stigma, fear of judgment, misconceptions, and the threat of violence. This qualitative study explores the strategies these adolescents use to navigate these challenges, drawing on resilience theory and asset-based approaches. METHODS: Between April 2018 and May 2019, cross-sectional semi-structured interviews were conducted with Ugandan adolescent girls aged 18-24 engaged in transactional sex to explore their experiences of PrEP disclosure. Data were analyzed using a thematic network analysis approach, focusing on how participants managed the social and psychological barriers to disclosure. RESULTS: The study found that stigma, misconceptions about PrEP, and fear of judgment or violence from clients and families were significant barriers to disclosure. However, adolescent girls employed multiple strategies to navigate these challenges. These included relying on peer support, selective disclosure to trusted individuals, and drawing on personal strength and resilience. Support from healthcare providers and access to youth-friendly health services further helped participants manage the risks associated with PrEP disclosure. Many participants used a combination of these strategies, adapting their approach to different social contexts. CONCLUSION: This study highlights the complex strategies adolescent girls engaged in transactional sex in Uganda use to disclose PrEP use amidst significant barriers. The findings emphasize the need for targeted interventions that focus on strengthening peer support, enhancing the role of healthcare providers, and creating safe spaces for disclosure. By integrating these strategies into PrEP delivery models, public health efforts can empower these vulnerable populations to disclose and adhere to PrEP more confidently, improving HIV prevention outcomes.

摘要

引言:在乌干达,从事性交易的少女中披露口服暴露前预防(PrEP)的使用情况是一个复杂的过程,受到耻辱感、对评判的恐惧、误解以及暴力威胁的影响。这项定性研究借鉴复原力理论和基于资产的方法,探讨这些青少年用于应对这些挑战的策略。 方法:在2018年4月至2019年5月期间,对年龄在18 - 24岁、从事性交易的乌干达少女进行了横断面半结构化访谈,以探讨她们披露PrEP使用情况的经历。使用主题网络分析方法对数据进行分析,重点关注参与者如何应对披露的社会和心理障碍。 结果:研究发现,耻辱感、对PrEP的误解以及对来自客户和家庭的评判或暴力的恐惧是披露的重大障碍。然而,少女们采用了多种策略来应对这些挑战。这些策略包括依靠同伴支持、有选择地向信任的人披露,以及利用个人力量和复原力。医疗保健提供者的支持和获得对青少年友好的健康服务进一步帮助参与者管理与PrEP披露相关的风险。许多参与者结合使用这些策略,根据不同的社会背景调整方法。 结论:本研究强调了乌干达从事性交易的少女在存在重大障碍的情况下披露PrEP使用情况所采用的复杂策略。研究结果强调了有针对性干预措施的必要性,这些措施应侧重于加强同伴支持、增强医疗保健提供者的作用以及为披露创造安全空间。通过将这些策略纳入PrEP提供模式,公共卫生工作可以使这些弱势群体更自信地披露和坚持PrEP,改善艾滋病毒预防成果。

相似文献

[1]
Identifying barriers and coping strategies for pre-exposure prophylaxis disclosure: experiences of Ugandan adolescent girls engaged in transactional sex-a qualitative study.

Front Glob Womens Health. 2025-3-20

[2]
Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe.

AIDS Behav. 2024-12

[3]
Uptake of and adherence to oral pre-exposure prophylaxis among adolescent girls and young women at high risk of HIV-infection in Kampala, Uganda: A qualitative study of experiences, facilitators and barriers.

BMC Womens Health. 2022-11-10

[4]
The influence of HIV-related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study.

J Int AIDS Soc. 2020-3

[5]
Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa.

BMC Public Health. 2022-10-14

[6]
Experiences with Oral Pre-Exposure Prophylaxis (PrEP) Service Delivery and Use Among Adolescent Girls and Young Women (AGYW) in Routine Primary Care Settings, South Africa.

AIDS Behav. 2025-4

[7]
"They are not HIV treatments drugs; they are preventive drugs (PrEP)". Experiences of PrEP uptake among vulnerable adolescent girls and young women in Tanzania.

PLoS One. 2025-1-8

[8]
Barriers to PrEP use and adherence among adolescent girls and young women in Eastern, Southern, and Western Africa: a scoping review.

BMC Womens Health. 2024-12-26

[9]
Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among South African adolescent girls and young women and its perceived impact on adherence.

PLoS One. 2021

[10]
Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa.

J Int AIDS Soc. 2024-5

本文引用的文献

[1]
Applying implementation science frameworks to understand why fisherfolk continue or discontinue pre-exposure prophylaxis for HIV prevention in Uganda: a qualitative analysis.

BMJ Glob Health. 2025-1-22

[2]
Enhanced Oral Pre-exposure Prophylaxis (PrEP) Implementation for Ugandan Fisherfolk: Pilot Intervention Outcomes.

AIDS Behav. 2024-10

[3]
HIV pre-exposure prophylaxis uptake, retention and adherence among female sex workers in sub-Saharan Africa: a systematic review.

BMJ Open. 2024-4-25

[4]
"Take services to the people": strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda.

Addict Sci Clin Pract. 2024-2-23

[5]
Effectiveness of PrEPTECH: Findings From a 180-Day Randomized Controlled Trial of a Pre-Exposure Prophylaxis Telehealth Intervention.

J Acquir Immune Defic Syndr. 2024-4-15

[6]
Family influences on oral PrEP use among adolescent girls and young women in Kenya and South Africa.

PLoS One. 2023

[7]
The Effect of Disclosure of PrEP Use on Adherence Among African Young Women in an Open-Label PrEP Study: Findings from HPTN 082.

AIDS Behav. 2024-5

[8]
"I know why I am taking this pill": Young women navigation of disclosure and support for PrEP uptake and adherence in Eastern Cape Province, South Africa.

PLOS Glob Public Health. 2023-1-20

[9]
Understanding Oral Prep Interest Among South African Adolescents: The Role of Perceived Parental Support and PrEP Stigma.

AIDS Behav. 2023-6

[10]
Uptake of and adherence to oral pre-exposure prophylaxis among adolescent girls and young women at high risk of HIV-infection in Kampala, Uganda: A qualitative study of experiences, facilitators and barriers.

BMC Womens Health. 2022-11-10

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