Barcelona 2013
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| Abstract #193 - Biomedical Prevention | ||||
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Session: 40.1: Biomedical Prevention (Parallel) on Tuesday @ 16.30-18.30 in Raval Chaired by Olive Shisana, Chinese Authors: Presenting Author: Dr Elizabeth Montgomery - RTI International, United States |
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| Additional Authors: Dr. Prashant Sharma, Dr. Manorama Bhargava, | ||||
| Aim: Lately, antiretroviral (ARV) based Pre-exposure Prophylaxis (PrEP) trials has emerged as a promising new HIV prevention strategy. However, there has been mixed results across several PrEP trials and populations, with variable levels of adherence being a major culprit. It is not clear how ARVs ? traditionally used for HIV treatment ? are perceived by participants, and how these views may affect use of the products as preventatives. Using a socio-ecological framework, we explored participants? perspectives and experiences with using ARV containing products for HIV prevention in the VOICE trial. | ||||
| Method / Issue: We conducted a qualitative study at the Johannesburg site of VOICE, a multisite double-blind placebo-controlled randomized trial testing three products: tenofovir gel, oral tenofovir and oral Truvada®. In the VOICE-C ancillary study, 102 randomly selected female VOICE participants, were interviewed through in-depth interviews (n=41); serial ethnographic interviews (n=21) or Focus Group Discussions (n=40). All interviews were audiotaped, transcribed, translated, and coded thematically for analysis. | ||||
| Results / Comments: Of the 102 participants, the mean age was 27, 43% had no current income, 96% had a primary sex partner, with whom 43% co-habitated, 27% were Zulu speaking and 29% considered Johannesburg to be home. A majority of participants understood that the products tested in VOICE contained ARVs, more so for the tablets than for the gel. However, the concept of ARV for prevention was understood to varying degrees. While all participants were clear about their own HIV-negative serostatus, and some distinctly articulated the trial?s purpose, there was a general sense that ARVs are ?for sick people?. This led several to question the researchers? logic of giving ARVs to HIV uninfected participants, and highlighted participants? confusion about the drugs? mechanisms of action. The association between taking ARVs and being perceived as HIV positive was described in women?s reports of others? reactions and discourses, and their frequent expectation of being misjudged and misinterpreted when taking the study products. The stigma associating ARV-based products ? mostly the tablets ? with HIV was pervasive through rumors and gossip in the community, in the workplace, and with housemates, sex partners and family members. Stigma resulted in concealed use of products, non-disclosure as well as occasional relationship conflicts, some leading to early study termination. Several participants wondered if the products and/or participation in the trial itself would actually ?bring sickness? (HIV), create side effects or affect their overall health. Yet statements by other participants indicated they felt protected by the products, and these were substantiated by anecdotal accounts of the drugs? perceived power: from a participant whose mother stole her tablets to protect herself from a promiscuous husband, to another who inserted gel twice daily for a month after being raped. | ||||
| Discussion: ARV-based prevention is a novel concept, and therefore may be difficult to understand and internalize by study participants and those around them. HIV stigma and secrecy fueled a range of concerns about taking the study products when being HIV-seronegative, and participants? reactions ranged from full endorsement of PrEP, to uncertainty and even conspiracy concerns about researchers? ultimate motives. | ||||
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