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What motivates serodiscordant couples to prevent HIV transmission within their relationships: findings from a PrEP implementation study in Kenya.

Authors
  • Patel, Rena C1
  • Leddy, Anna M2
  • Odoyo, Josephine3
  • Anand, Keerthana4
  • Stanford-Moore, Gaelen5
  • Wakhungu, Imeldah3
  • Bukusi, Elizabeth A3, 6
  • Baeten, Jared M7
  • Brown, Joelle M8
  • 1 a Division of Allergy and Infectious Diseases, Department of Medicine , University of Washington , Seattle , WA , USA.
  • 2 b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
  • 3 c Centre for Microbiologic Research , Kenya Medical Research Institute , Nairobi , Kenya. , (Kenya)
  • 4 d Center for Global Health Sciences , University of California , San Francisco , CA , USA.
  • 5 e School of Medicine , University of California , San Francisco , CA , USA.
  • 6 f Departments of Obstetrics and Gynecology and Global Health , University of Washington , Seattle , WA , USA.
  • 7 g Departments of Epidemiology, Global Health, and Medicine , University of Washington , Seattle , WA , USA.
  • 8 h Departments of Epidemiology and Biostatistics and Obstetrics, Gynecology, and Reproductive Sciences , University of California , San Francisco , CA , USA.
Type
Published Article
Journal
Culture, health & sexuality
Publication Date
Sep 14, 2017
Pages
1–15
Identifiers
DOI: 10.1080/13691058.2017.1367421
PMID: 28903628
Source
Medline
Keywords
License
Unknown

Abstract

With the planned scale-up of pre-exposure prophylaxis (PrEP) for HIV prevention among serodiscordant couples in resource-limited settings, gaining an understanding of what motivates serodiscordant couples to prevent HIV is critical. We conducted 44 semi-structured, in-depth individual or couple interviews with 63 participants (33 HIV-infected and 30 HIV-uninfected participants) enrolled in a prospective implementation study of oral antiretroviral-based prevention in Kisumu, Kenya. Transcripts were iteratively analysed using inductive content analysis. Findings point to the importance of maintaining the emotional and economic stability of the partnership and family as motivators in preventing HIV transmission. Female participants identified fear of blame or potential violence for transmitting HIV as a motivator. Furthermore, couples primarily held the HIV-infected individual responsible for HIV prevention, but also held women more accountable for the use of prevention methods such as condoms. These themes substantiate traditional gender norms but also reveal how dyadic interdependence challenges these norms. As programmes in resource-limited settings scale up PrEP access, they should simultaneously capitalise on HIV serodiscordant couples' motivations for HIV prevention and address gender norms so women do not find themselves unduly responsible for the prevention of HIV transmission.

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