Female-initiated methods of
HIV prevention are needed to address barriers to HIV prevention rooted in
gender inequalities. Understanding the sociocultural context of pre-exposure
prophylaxis (PrEP) trials, including gender-based violence, is thus critical.
MTN-003C (VOICE-C), a qualitative sub-study of the larger MTN-003 (VOICE)
trial, examined sociocultural barriers and facilitators to PrEP amongst women
in Johannesburg.
We conducted focus-group discussions, in-depth interviews and
ethnographic interviews with 102 trial participants, 22 male partners, 17
community advisory board members and 23 community stakeholders. We analysed how
discussions of rape are emblematic of the gendered context in which HIV risk
occurs.
Rape emerged spontaneously in half of discussions with community
advisory board members, two-thirds with stakeholders and among one-fifth of
interviews/discussions with trial participants. Rape was used to reframe HIV
risk as external to women's or partner's behaviour and to justify the
importance of PrEP.
Our research illustrates how women, in contexts of high
levels of sexual violence, may use existing gender inequalities to negotiate
PrEP use. This suggests that future interventions should simultaneously address
harmful gender attitudes, as well as equip women with alternative means to
negotiate product use, in order to more effectively empower women to protect themselves
from HIV.
Purchase full article at: http://goo.gl/2MAFAO
By:
- 1 Women's Global Health Imperative, RTI International , San Francisco , USA.
- 2 Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Johannesburg , South Africa.
- 3 Center for AIDS Prevention Studies, Department of Medicine , University of California , San Francisco , USA.
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