Views of HIV-negative partners in heterosexual serodiscordant relationships regarding HIV pre-exposure prophylaxis: a qualitative study
Joana R. S. P. Falcão A F , Catriona C. Bradshaw A B D , Cameryn C. Garrett C , Jade E. Bilardi B D , Marcus Y. Chen B D , Iryna Zablotska E , Christopher K. Fairley B D and Henrietta Williams A B
+ Author Affiliations
- Author Affiliations
A Sexual Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia.
B Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic. 3053, Australia.
C Gender and Women’s Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic. 3010, Australia.
D Central Clinical School, Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Vic. 3800, Australia.
E The Kirby Institute, The University of New South Wales, Sydney, NSW 2052, Australia.
F Corresponding author. Email: joafalcao@gmail.com
Sexual Health 13(4) 345-352 https://doi.org/10.1071/SH15143
Submitted: 20 July 2015 Accepted: 8 March 2016 Published: 26 May 2016
Abstract
Background: Pre-exposure prophylaxis (PrEP) may be an effective option for HIV prevention among heterosexual serodiscordant couples. However, there are knowledge gaps in social research about PrEP in heterosexual serodiscordant relationships, including motivations and barriers to its use and possible impacts of PrEP uptake on the sexual practices of these couples. The aim of this study was to explore the views of HIV-negative men and women in stable serodiscordant heterosexual relationships about the possible use of PrEP. Methods: Semi-structured interviews were used to understand participants’ views on the use of PrEP. Interviews were conducted face-to-face or by telephone and transcribed verbatim for thematic analysis. Results: In total, 13 HIV-negative partners were interviewed; six men and seven women. Participants demonstrated a high interest in the use of PrEP for conception. PrEP was also considered an option for general HIV prevention, although men saw more benefits for this use than women. Participants’ main concerns around PrEP usage were about cost, efficacy, daily adherence and side-effects. HIV-positive partner support is likely to play a central role for PrEP uptake and adherence. Conclusions: This study is one of the first studies to explore the views of HIV-negative heterosexual partners in serodiscordant relationships around the use of PrEP while trying to conceive, as well as for general HIV prevention. These study results provide new insights for the further development of guidelines governing the use of PrEP for serodiscordant couples.
Additional keywords: Australia, couples, HIV prevention, qualitative.
References
[1] Cooper DA. Life and death in the cART era. Lancet 2008; 372 266–7.| Life and death in the cART era.Crossref | GoogleScholarGoogle Scholar | 18657689PubMed |
[2] Wilson DP, Law MG, Grulich AE, Cooper DA, Kaldor JM. Relation between HIV viral load and infectiousness: a model-based analysis. Lancet 2008; 372 314–20.
| Relation between HIV viral load and infectiousness: a model-based analysis.Crossref | GoogleScholarGoogle Scholar | 18657710PubMed |
[3] Cohen M, Muessig K, Smith M, Powers K, Kashuba A. Antiviral agents and HIV prevention: controversies, conflicts, and consensus. AIDS 2012; 26 1585–98.
| Antiviral agents and HIV prevention: controversies, conflicts, and consensus.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtFOru7rK&md5=6048bc53a769b7486b8d7fdb245083e6CAS | 22507927PubMed |
[4] UNAIDS. AIDS epidemic update, 2009. Geneva: UNAIDS; 2009.
[5] Tai JH, Udoji MA, Barkanic G, Byrne DW, Rebeiro PF, Byram BR, Kheshti A, Carter JD, Graves CR, Raffanti SP, et al Pregnancy and HIV disease progression during the era of highly active antiretroviral therapy. J Infect Dis 2007; 196 1044–52.
| Pregnancy and HIV disease progression during the era of highly active antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 17763327PubMed |
[6] Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, et al Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012; 367 399–410.
| Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtlSltrbK&md5=3cb82387c09c4694dae4fa80e1fa8ad3CAS | 22784037PubMed |
[7] Koenig LJ, Lyles C, Smith DK. Adherence to antiretroviral medications for HIV pre-exposure prophylaxis: lessons learned from trials and treatment studies. Am J Prev Med 2013; 44 S91–8.
| Adherence to antiretroviral medications for HIV pre-exposure prophylaxis: lessons learned from trials and treatment studies.Crossref | GoogleScholarGoogle Scholar | 23253769PubMed |
[8] van der Straten A, Van Damme L, Haberer JE, Bangsberg DR. Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention. AIDS 2012; 26 F13–9.
| Unraveling the divergent results of pre-exposure prophylaxis trials for HIV prevention.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xls1Sluro%3D&md5=7a691d4b82d86e7b5f65c1d49fd559a1CAS | 22333749PubMed |
[9] Eisingerich AB, Wheelock A, Gomez GB, Garnett GP, Dybul MR, Piot PK. Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study. PLoS One 2012; 7 e28238
| Attitudes and acceptance of oral and parenteral HIV preexposure prophylaxis among potential user groups: a multinational study.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhsVShs70%3D&md5=7b230b9761446107bacd07684d08cdc6CAS | 22247757PubMed |
[10] Poynten IM, Jin F, Prestage GP, Kaldor JM, Imrie J, Grulich AE. Attitudes towards new HIV biomedical prevention technologies among a cohort of HIV-negative gay men in Sydney, Australia. HIV Med 2010; 11 282–8.
| Attitudes towards new HIV biomedical prevention technologies among a cohort of HIV-negative gay men in Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3czkvFSjtA%3D%3D&md5=e09a739d38caf8fa9564c004314c5da6CAS | 20015220PubMed |
[11] Brooks RA, Kaplan RL, Lieber E, Landovitz RJ, Lee S-J, Leibowitz AA. Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships. AIDS Care 2011; 23 1136–45.
| Motivators, concerns, and barriers to adoption of preexposure prophylaxis for HIV prevention among gay and bisexual men in HIV-serodiscordant male relationships.Crossref | GoogleScholarGoogle Scholar | 21476147PubMed |
[12] Van der Elst E, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, Kanungi J, Singh S, Haberer J, Priddy F, et al High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a Phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav 2013; 17 2162–72.
| High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a Phase I trial of intermittent and daily PrEP in at-risk populations in Kenya.Crossref | GoogleScholarGoogle Scholar | 23080358PubMed |
[13] Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV?: A review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention AIDS Behav 2014; 18 195–216.
| 23897125PubMed |
[14] Centers for Disease Control and Prevention Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. MMWR Morb Mortal Wkly Rep 2012; 61 586–9.
| 22874836PubMed |
[15] World Health Organization. Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: recommendations for use in the context of demonstration projects. Geneva: WHO; 2012.
[16] Abbas UL, Hood G, Wetzel AW, Mellors JW. Factors influencing the emergence and spread of HIV drug resistance arising from rollout of antiretroviral pre-exposure prophylaxis (PrEP). PLoS One 2011; 6 e18165
| Factors influencing the emergence and spread of HIV drug resistance arising from rollout of antiretroviral pre-exposure prophylaxis (PrEP).Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXltV2rsLY%3D&md5=689dd785c637b3977a7da3575cb90029CAS | 21525976PubMed |
[17] Eaton LA, Kalichman SC. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep 2007; 4 165–72.
| Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies.Crossref | GoogleScholarGoogle Scholar | 18366947PubMed |
[18] Cohen MS, Baden LR. Preexposure prophylaxis for HIV - where do we go from here? N Engl J Med 2012; 367 459–61.
| Preexposure prophylaxis for HIV - where do we go from here?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtlSltrfO&md5=277f54f359a7f2e89456929189098b11CAS | 22784041PubMed |
[19] Kim SC, Becker S, Dieffenbach C, Hanewall BS, Hankins C, Ying-Ru L, Mellors JW, O’Reilly K, Paxton L, Roffenbender JS, et al Planning for pre-exposure prophylaxis to prevent HIV transmission: challenges and opportunities. J Int AIDS Soc 2010; 13 24
| Planning for pre-exposure prophylaxis to prevent HIV transmission: challenges and opportunities.Crossref | GoogleScholarGoogle Scholar | 20624303PubMed |
[20] Matthews LT, Baeten JM, Celum C, Bangsberg DR. Periconception pre-exposure prophylaxis to prevent HIV transmission: benefits, risks, and challenges to implementation. AIDS 2010; 24 1975–82.
| Periconception pre-exposure prophylaxis to prevent HIV transmission: benefits, risks, and challenges to implementation.Crossref | GoogleScholarGoogle Scholar | 20679759PubMed |
[21] Ware NC, Wyatt MA, Haberer JE, Baeten JM, Kintu A, Psaros C, Safren S, Tumwesigye E, Celum CL, Bangsberg DR. What’s love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for HIV-serodiscordant couples. J Acquir Immune Defic Syndr 1999; 2012 463–8.
[22] Vernazza PL, Graf I, Sonnenberg-Schwan U, Geit M, Meurer A. Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child. AIDS 2011; 25 2005–8.
| Preexposure prophylaxis and timed intercourse for HIV-discordant couples willing to conceive a child.Crossref | GoogleScholarGoogle Scholar | 21716070PubMed |
[23] Whetham J, Taylor S, Charlwood L, Keith T, Howell R, McInnes C, Payne E, Home J, White D, Gilleece Y. Pre-exposure prophylaxis for conception (PrEP-C) as a risk reduction strategy in HIV-positive men and HIV-negative women in the UK. AIDS Care 2014; 26 332–6.
| Pre-exposure prophylaxis for conception (PrEP-C) as a risk reduction strategy in HIV-positive men and HIV-negative women in the UK.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3sfivVyitQ%3D%3D&md5=ec1abea98841b620df1b6288a33eff37CAS | 23876052PubMed |
[24] Rispel LC, Cloete A, Metcalf CA, Moody K, Caswell G. ‘It [HIV] is part of the relationship’: exploring communication among HIV-serodiscordant couples in South Africa and Tanzania. Cult Health Sex 2012; 14 257–68.
| ‘It [HIV] is part of the relationship’: exploring communication among HIV-serodiscordant couples in South Africa and Tanzania.Crossref | GoogleScholarGoogle Scholar | 22077668PubMed |
[25] Persson A. HIV-negativity in serodiscordant relationships: the absence, enactment, and liminality of serostatus identity. Med Anthropol 2011; 30 569–90.
| HIV-negativity in serodiscordant relationships: the absence, enactment, and liminality of serostatus identity.Crossref | GoogleScholarGoogle Scholar | 22026732PubMed |
[26] Lampe MA, Smith DK, Anderson GJE, Edwards AE, Nesheim SR. Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United States. Am J Obstet Gynecol 2011; 204 e481–8.
| Achieving safe conception in HIV-discordant couples: the potential role of oral preexposure prophylaxis (PrEP) in the United States.Crossref | GoogleScholarGoogle Scholar |
[27] Kelly C, Lohan M, Alderdice F, Spence D. Negotiation of risk in sexual relationships and reproductive decision-making amongst HIV sero-different couples. Cult Health Sex 2011; 13 815–27.
| Negotiation of risk in sexual relationships and reproductive decision-making amongst HIV sero-different couples.Crossref | GoogleScholarGoogle Scholar | 21452089PubMed |
[28] Persson A. Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status. Glob Public Health 2013; 8 209–20.
| Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status.Crossref | GoogleScholarGoogle Scholar | 23043414PubMed |
[29] Guy RJ, McDonald AM, Bartlett MJ, Murray JC, Giele CM, Davey TM, Appuhamy RD, Knibbs P, Coleman D, Hellard ME, et al HIV diagnoses in Australia: diverging epidemics within a low-prevalence country. Med J Aust 2007; 187 437–40.
| 17937639PubMed |
[30] Sandelowski M. Whatever happened to qualitative description? Res Nurs Health 2000; 23 334–40.
| 1:STN:280:DC%2BD3cvhsFCmtw%3D%3D&md5=08c9713bbc439c5306a9fa3e04c3203dCAS | 10940958PubMed |
[31] Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description - the poor cousin of health research? BMC Med Res Methodol 2009; 9 52
| Qualitative description - the poor cousin of health research?Crossref | GoogleScholarGoogle Scholar | 19607668PubMed |
[32] Whiteside YO, Harris T, Scanlon C, Clarkson S, Duffus W. Self-perceived risk of HIV infection and attitudes about preexposure prophylaxis among sexually transmitted disease clinic attendees in South Carolina. AIDS Patient Care STDS 2011; 25 365–70.
| Self-perceived risk of HIV infection and attitudes about preexposure prophylaxis among sexually transmitted disease clinic attendees in South Carolina.Crossref | GoogleScholarGoogle Scholar | 21470046PubMed |
[33] Connolly MP, Hoorens S, Chambers GM. The costs and consequences of assisted reproductive technology: an economic perspective. Hum Reprod Update 2010; 16 603–13.
| The costs and consequences of assisted reproductive technology: an economic perspective.Crossref | GoogleScholarGoogle Scholar | 20530804PubMed |
[34] Gilling-Smith C, Nicopoullos JDM, Semprini AE, Frodsham LCG. HIV and reproductive care–a review of current practice. Int J Obst Gynaecol 2006; 113 869–78.
| HIV and reproductive care–a review of current practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28votlWrsw%3D%3D&md5=7119c1246af722a61b69eff2fb4095c1CAS |
[35] McDonald K. ‘The old-fashioned way’: conception and sex in serodiscordant relationships after ART. Cult Health Sex 2011; 13 1119–33.
| ‘The old-fashioned way’: conception and sex in serodiscordant relationships after ART.Crossref | GoogleScholarGoogle Scholar | 21916671PubMed |
[36] Giles ML, Barak S, Baker G, Perna S, Tabrizi S, Greengrass V, Bourne H, Clarke GN, Peak SA, Hoy JF, et al Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia. Med J Aust 2011; 195 599–601.
| Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia.Crossref | GoogleScholarGoogle Scholar | 22107010PubMed |
[37] Newmeyer T, Tecimer SN, Jaworsky D, Chihrin S, Gough K, Rachlis A, Martin J, Mohammed S, Loutfy MR. Case series of fertility treatment in HIV-discordant couples (male positive, female negative): the Ontario experience. PLoS One 2011; 6 e24853
| Case series of fertility treatment in HIV-discordant couples (male positive, female negative): the Ontario experience.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhtlCmtr%2FF&md5=0c13d3a30d67af19847011069745df8dCAS | 21969863PubMed |
[38] Peak SA, Nowoweiski SJ, Giles ML. A qualitative study of HIV serodiscordant patients accessing assisted reproductive treatment. J Reprod Infant Psychol 2012; 30 413–22.
| A qualitative study of HIV serodiscordant patients accessing assisted reproductive treatment.Crossref | GoogleScholarGoogle Scholar |
[39] Sunderam S, Hollander L, Macaluso M, Vucetich A, Jamieson DJ, Osimo F, Duerr A, Semprini AE. Safe conception for HIV discordant couples through sperm-washing: experience and perceptions of patients in Milan, Italy. Reprod Health Matters 2008; 16 211–9.
| Safe conception for HIV discordant couples through sperm-washing: experience and perceptions of patients in Milan, Italy.Crossref | GoogleScholarGoogle Scholar | 18513622PubMed |
[40] Azemar FH, Daudin M, Bujan L. Assisted reproductive technologies for serodiscordant couples: desire for child and pregnancy versus the fact of illness. Gynecol Obstet Fertil 2010; 38 58–69.
| 20022790PubMed |
[41] Tripathi A, Whiteside YO, Duffus WA. Perceptions and attitudes about preexposure prophylaxis among seronegative partners and the potential of sexual disinhibition. South Med J 2013; 106 558–64.
| Perceptions and attitudes about preexposure prophylaxis among seronegative partners and the potential of sexual disinhibition.Crossref | GoogleScholarGoogle Scholar | 24096949PubMed |
[42] Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev 2012; CD003255
[43] Mugwanya KK, Donnell D, Celum C, Thomas KK, Ndase P, Mugo N, Katabira E, Ngure K, Baeten JM. Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis. Lancet Infect Dis 2013; 13 1021–8.
| Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis.Crossref | GoogleScholarGoogle Scholar | 24139639PubMed |
