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01-07-2020 | Human Immunodeficiency Virus | Original Paper

Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study

Authors: Carol S. Camlin, Catherine A. Koss, Monica Getahun, Lawrence Owino, Harriet Itiakorit, Cecilia Akatukwasa, Irene Maeri, Robert Bakanoma, Anjeline Onyango, Frederick Atwine, James Ayieko, Jane Kabami, Florence Mwangwa, Mucunguzi Atukunda, Asiphas Owaraganise, Dalsone Kwarisiima, Norton Sang, Elizabeth A. Bukusi, Moses R. Kamya, Maya L. Petersen, Craig R. Cohen, Edwin D. Charlebois, Diane V. Havlir

Published in: AIDS and Behavior | Issue 7/2020

Abstract

Few studies have sought to understand factors influencing uptake and continuation of pre-exposure prophylaxis (PrEP) among young adults in sub-Saharan Africa in the context of population-based delivery of open-label PrEP. To address this gap, this qualitative study was implemented within the SEARCH study (NCT#01864603) in Kenya and Uganda, which achieved near-universal HIV testing, and offered PrEP in 16 intervention communities beginning in 2016–2017. Focus group discussions (8 groups, n = 88 participants) and in-depth interviews (n = 23) with young adults who initiated or declined PrEP were conducted in five communities, to explore PrEP-related beliefs and attitudes, HIV risk perceptions, motivations for uptake and continuation, and experiences. Grounded theoretical methods were used to analyze data. Young people felt personally vulnerable to HIV, but perceived the severity of HIV to be low, due to the success of antiretroviral therapy (ART): daily pill-taking was more threatening than the disease itself. Motivations for PrEP were highly gendered: young men viewed PrEP as a vehicle for safely pursuing multiple partners, while young women saw PrEP as a means to control risks in the context of engagement in transactional sex and limited agency to negotiate condom use and partner testing. Rumors, HIV/ART-related stigma, and desire for “proof” of efficacy militated against uptake, and many women required partners’ permission to take PrEP. Uptake was motivated by high perceived HIV risk, and beliefs that PrEP use supported life goals. PrEP was often discontinued due to dissolution of partnerships/changing risk, unsupportive partners/peers, or early side effects/pill burden. Despite high perceived risks and interest, PrEP was received with moral ambivalence because of its associations with HIV/ART and stigmatized behaviors. Delivery models that promote youth access, frame messaging on wellness and goals, and foster partner and peer support, may facilitate uptake among young people.

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Title: Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study
Authors: Carol S. Camlin
Catherine A. Koss
Monica Getahun
Lawrence Owino
Harriet Itiakorit
Cecilia Akatukwasa
Irene Maeri
Robert Bakanoma
Anjeline Onyango
Frederick Atwine
James Ayieko
Jane Kabami
Florence Mwangwa
Mucunguzi Atukunda
Asiphas Owaraganise
Dalsone Kwarisiima
Norton Sang
Elizabeth A. Bukusi
Moses R. Kamya
Maya L. Petersen
Craig R. Cohen
Edwin D. Charlebois
Diane V. Havlir
Publication date: 01-07-2020
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: AIDS and Behavior / Issue 7/2020
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-020-02780-x

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