The influence of HIV-related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study
The influence of HIV-related stigma on PrEP disclosure and adherence among adolescent girls and young women in HPTN 082: a qualitative study
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DOI：
10.1002/jia2.25463
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发表时间：
2020-03-01
影响因子：
6
通讯作者：
Delany-Moretlwe, Sinead
中科院分区：
文献类型：
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作者：
Velloza, Jennifer;Khoza, Nomhle;Delany-Moretlwe, Sinead
在疗效试验中，耻辱感和信息披露问题一直是非洲少女和年轻妇女（AGYW）坚持口服暴露前预防（PrEP）的主要障碍。我们的目的是在一项开放标签PrEP研究中了解这些因素对非洲AGYW的影响。方法HPTN 082是一项开放标签PrEP研究，于2016年至2018年在津巴布韦哈拉雷、南非开普敦和约翰内斯堡的AGYW（16至24岁）中进行。开始PrEP的妇女被随机分配到标准依从性支持（咨询、双向短信、每月依从性俱乐部）或标准支持加药物水平反馈。在13周和26周的研究访问后，对67名AGYW进行了系列深入访谈，以探讨耻感、披露和PrEP依从性的经历。我们通过编码转录、备忘录写作和图表来分析数据，总结主题。结果AGYW描述了与性活动相关的耻辱感(例如；“人们说我是妓女”)，并且因为服用抗逆转录病毒药物而被认为感染了艾滋病毒(例如：“我丈夫的朋友说我感染了艾滋病毒”)。预期耻辱的参与者不愿透露PrEP的使用情况，并报告了依从性挑战。披露也导致了污名化的经历。在所有网站中，对耻辱和披露挑战的负面描述在第一次采访中更为常见。在第二次访谈中，参与者经常将信息披露描述为一种“赋权”方式，以对抗社区层面的PrEP耻辱；许多人表示，他们在社区中积极讨论预防措施（例如成为“社区预防措施大使”），这提高了他们采取预防措施的能力，并鼓励其他人使用预防措施。正在进行的HPTN 082研究活动（例如咨询会议、依从性俱乐部）促进了这些赋权的披露经验，在这些活动中，他们可以讨论与预防措施相关的耻辱、披露和PrEP依从性问题。污名化和披露挑战是新开始使用PrEP的非洲妇女最初关注的问题，但许多人在使用PrEP的前六个月有权披露PrEP使用情况，这有助于她们应对污名化，并感到更有能力定期服用PrEP。预防措施规划可通过以社区和诊所为基础的讨论、依从性俱乐部以及使性行为和预防措施使用正常化的活动促进信息披露，从而减少污名，提高预防措施依从性，从而提高有效性。
Introduction Stigma and disclosure concerns have been key barriers to oral pre-exposure prophylaxis (PrEP) adherence for African adolescent girls and young women (AGYW) in efficacy trials. We aimed to understand the impact of these factors among African AGYW in an open-label PrEP study.Methods HPTN 082 was an open-label PrEP study among AGYW (ages 16 to 24) in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa from 2016 to 2018. Women starting PrEP were randomized to standard adherence support (counselling, two-way SMS, monthly adherence clubs) or standard support plus drug-level feedback. Serial in-depth interviews were conducted among 67 AGYW after 13-week and 26-week study visits to explore experiences of stigma, disclosure and PrEP adherence. We analysed data by coding transcripts and memo-writing and diagramming to summarize themes.Results AGYW described stigma related to sexual activity (e.g. "people say I'm a prostitute") and being perceived to be living with HIV because of taking antiretrovirals (e.g. "my husband's friends say I'm HIV infected"). Participants who anticipated stigma were reluctant to disclose PrEP use and reported adherence challenges. Disclosure also resulted in stigmatizing experiences. Across all sites, negative descriptions of stigma and disclosure challenges were more common in the first interview. In the second interview, participants often described disclosure as an "empowering" way to combat community-level PrEP stigma; many said that they proactively discussed PrEP in their communities (e.g. became a "community PrEP ambassador"), which improved their ability to take PrEP and encourage others to use PrEP. These empowering disclosure experiences were facilitated by ongoing HPTN 082 study activities (e.g. counselling sessions, adherence clubs) in which they could discuss PrEP-related stigma, disclosure and PrEP adherence issues.Conclusions Stigma and disclosure challenges were initial concerns for African AGYW newly initiating PrEP but many were empowered to disclose PrEP use over their first six months of PrEP use, which helped them cope with stigma and feel more able to take PrEP regularly. PrEP programmes can foster disclosure through community and clinic-based discussion, adherence clubs and activities normalizing sexual behaviour and PrEP use, which can reduce stigma and improve PrEP adherence and thus effectiveness.