PrEP reminds me that I am the one to take responsibility of my life: a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini
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PrEP reminds me that I am the one to take responsibility of my life : a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini. / Bjertrup, Pia Juul.
In: BMC Public Health, Vol. 21, 727, 2021.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - PrEP reminds me that I am the one to take responsibility of my life
T2 - a qualitative study exploring experiences of and attitudes towards pre-exposure prophylaxis use by women in Eswatini
AU - Bjertrup, Pia Juul
PY - 2021
Y1 - 2021
N2 - BackgroundPre-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.MethodsWe 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.ResultsPrEP 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.ConclusionsUnlike 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.
AB - BackgroundPre-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.MethodsWe 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.ResultsPrEP 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.ConclusionsUnlike 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.
KW - Faculty of Social Sciences
KW - Eswatini
KW - Qualitative research
KW - pre-exposure prophylaxis
KW - Hiv
KW - Self care
KW - Women
U2 - 10.1186/s12889-021-10766-0
DO - 10.1186/s12889-021-10766-0
M3 - Journal article
C2 - 33853575
VL - 21
JO - BMC Public Health
JF - BMC Public Health
SN - 1471-2458
M1 - 727
ER -
ID: 259979777