PrEP uptake and persistence amongst HIV-negative women who exchange sex for money or commodities in Kampala, Uganda: A qualitative inquiry assessing the influence of pregnancy.
PrEP uptake and persistence amongst HIV-negative women who exchange sex for money or commodities in Kampala, Uganda: A qualitative inquiry assessing the influence of pregnancy.
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DOI：
10.1371/journal.pgph.0000434
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发表时间：
2023
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以性换取金钱或商品的年轻怀孕妇女感染艾滋病毒的生物和社会风险更高。PREP是一种有效的艾滋病毒预防手段，包括在怀孕期间。这项研究旨在探索PrEP的态度、经历和挑战，以了解是什么激励或限制了PrEP的摄取和坚持，特别是在这一年轻女性群体的怀孕期间。对23名参与者进行了半结构化访谈，他们是从乌干达坎帕拉妇女健康项目诊所的预防PrEP(Poppi)研究中招募的。Poppi的纳入标准包括15-24岁的未感染艾滋病毒的女性，她们以性换取金钱或商品。采访的重点是PrEP和怀孕的经历。使用框架分析方法对数据进行了分析。主要主题包括参与者、阻碍和遵守PrEP的障碍和促进者。启动PrEP的原因包括对自治和代理的渴望、对合作伙伴的不信任以及社会支持。参与者表达了在开始或持续使用PrEP方面的挑战，包括怀孕、PrEP的获得以及感觉到或感觉到的耻辱。在怀孕期间，参与者改变PrEP使用的主要动机要么是了解PrEP对他们婴儿的安全性，要么是对他们艾滋病毒风险的看法的改变。在有怀孕经历的参与者和没有怀孕经历的参与者中，这些因素中的许多都是相似的。这项研究强调了解决PrEP摄取和持续的障碍和促进者的重要性，特别是在风险增加的怀孕期间，采用多层次的方法。以社区为导向的教育、减少耻辱的活动以及获得初级保健方案的机会，可以作为坚持这一原则的手段。制定强有力的预防接种计划支助服务和关于在高危妇女孕期使用预防接种计划的指导方针及其执行战略，对于控制关键人群中的艾滋病毒和消除艾滋病毒母婴传播至关重要。
Pregnant young women who exchange sex for money or commodities are at elevated biological and social risk for HIV acquisition. PrEP serves as an effective means of HIV prevention, including during pregnancy. This study aimed to explore attitudes, experiences and challenges with PrEP to understand what motivates or limits PrEP uptake and adherence specifically during pregnancy among this population of young women. Semi-structured interviews were conducted with 23 participants, recruited from the Prevention on PrEP (POPPi) study in the Good Health for Women Project clinic in Kampala, Uganda. POPPi’s inclusion criteria comprised of HIV-uninfected women, aged 15–24, who exchange sex for money or commodities. Interviews focused on experience with PrEP and pregnancy. Data were analyzed utilizing a framework analysis approach. Key themes were comprised of participant barriers to and facilitators of PrEP uptake and adherence. Reasons for PrEP initiation included desire for autonomy and agency, mistrust of partners, and social support. Participants expressed challenges with initiating or sustaining their use of PrEP, including pregnancy, PrEP access and perceived or felt stigma. During pregnancy, participants’ primary motivators for altering PrEP use were either understanding of PrEP safety for their baby or changes in perceptions of their HIV risk. Many of these factors were similar across participants who had experience with pregnancy and those who did not. This study highlights the importance of addressing barriers to and facilitators of PrEP uptake and persistence, especially during pregnancy where risk is elevated, with a multi-level approach. Community-oriented education, stigma reduction activities alongside access to PrEP, can serve as means for adherence. The development of robust PrEP support services and guidelines regarding PrEP use during pregnancy among high-risk women, and strategies for their implementation, are of utmost importance for the control of HIV in key populations and the elimination of mother-to-child transmission of HIV.