High-risk women identify reasons for relying only on PrEP

Data from a survey of women at high-risk for HIV in Kenya and South Africa suggest that many women on pre-exposure prophylaxis, or PrEP, may engage in riskier sexual behaviors, according to presentations presented at AIDS 2014.

In a secondary qualitative analysis, Amy Corneli, PhD, of FHI 360 in Durham, and colleagues explored potential reasons that these women would engage in riskier behavior. The most common reason was a belief that PrEP offers enough protection to replace or reduce the need for condoms.

Amy Corneli

“The difficulties women face in negotiating condom use is well-documented and some women believe that PrEP provides a mechanism to resolve these conflicts and struggles while still reducing their risk of HIV infection,” Corneli told Infectious Disease News. “Guidance for PrEP must address the potential that some women using PrEP will discontinue using condoms, even if they are encouraged to continue using them while on PrEP.”

Corneli and colleagues administered the survey to 799 women in Bondo, Kenya and Soshanguve, South Africa, asking about the likelihood of using condoms with a casual partner, a regular partner and a transactional sex partner, and the likelihood of having sex with a new partner while taking PrEP and not taking PrEP. They found that between 27% and 40% of women may engage in riskier sexual practices if they were taking PrEP.

For the qualitative study, the researchers conducted interviews with 60 of the participants to determine the reasons women would participate in riskier behavior while taking PrEP. Besides the belief that PrEP was effective as the sole HIV prevention method, the participants also indicated that condoms were a reason for conflict in relationships, and PrEP would resolve this conflict. Lastly, the women believed that sex without a condom or sex with a new partner was necessary to receive material goods and/or financial assistance.

Corneli said that while PrEP does provide an opportunity to reduce the risk of HIV infection among women in sub-Saharan Africa who unable to use condoms consistently, women should be encouraged to combine PrEP with other risk reduction strategies for HIV prevention because consistent adherence to PrEP may be challenging.

“Women need guidance on all options available to support their sexual health so they can make informed decisions when using PrEP,” Corneli said. “The importance of adherence to PrEP must be reinforced because high adherence is necessary for best protection against HIV. Guidance must also encourage regular testing for other sexually transmitted infections and the use of contraceptives, particularly among women who choose not to use condoms.” — by Emily Shafer

For more information:

Corneli A. #MOPDD0104.

Corneli A. #MOPE296. Both presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.