“Now that PrEP is reducing the risk of transmission of HIV, why then do you still insist that we use condoms?” the condom quandary among PrEP users and health care providers in Kenya

Irungu, Elizabeth; Ngure, Kenneth; Mugwanya, Kenneth; Awuor, Merceline; Dollah, Annabelle; Ongolly, Fernandos; Mugo, Nelly; Bukusi, Elizabeth A.; Wamoni, Elizabeth; Odoyo, Josephine; Morton, Jennifer; Barnabee, Gena; Mukui, Irene; Baeten, Jared M.; O’Malley, Gabrielle

doi:10.1080/09540121.2020.1744507

Cited by 16 publications

(23 citation statements)

References 55 publications

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“…The benefits of condom use to prevent HIV sexual transmission are well settled in literature [4,5,34]. However, its use is influenced by several factors, like gender relations and, maybe fundamentally, by relations of pleasure, affection, and desire [32,34,35]. In addition, the notions of risk and prevention to STI based on condoms are running out as new HIV prevention strategies emerge, being necessary to expand prevention awareness to a combined-strategy perspective beyond the prevalence of condoms [34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Beyond that, studies have described health professionals as unprepared to address issues related to sexuality, especially over the unknowledge regarding preventive strategies and resources available for PLHIV and serodiscordant couples [22,35,[40][41][42]. One of them identified reluctance from health providers to prescribe or advise preventive strategies even though they are aware of its safety and efficacy are already well established by scientific evidence [40].…”

Section: Discussionmentioning

confidence: 99%

“…Risk management of HIV transmission by serodifferent couples is important not only because of HIV acquisition exposure by the uninfected partner, but also due to the autonomy of choosing the preventive strategies that are convenient for them and to reduce tensions, fear, and anxieties related to the risk of transmission, permiting them to enjoy their sex lives with pleasure and security [22,35,43].…”

Section: Discussionmentioning

confidence: 99%

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Serodiscordance predictors among couples in the HIV context: implications for health care

et al. 2021

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Background After HIV diagnosis, people maintain, reestablish their sexual lives, or build new relationships, often with HIV seronegative partners. Therefore, understanding the factors concerning couple-vulnerability is essential in order to design effective HIV preventive strategies. We examined HIV serodiscordant couples prevalence and their associated factors from a Brazilian city. Methods This is a cross-sectional analytical study carried out with people living with HIV (PLHIV) who had an active sex life and were engagement in HIV health care follow-up. Data were collected using a semi-structured questionnaire during individual interviews. We analyzed data using bivariate and multiple logistic regression analyses. Results There was 72.0% of HIV serodiscordant partnerships. Those who inconsistently used condoms (aOR: 0.3[0.13–0.7]) and/or had HIV detectable viral load (aOR: 0.29 [0.12–0.7]) were less likely to have an HIV serodiscordant sexual partner. On other hand, the lack of HIV transmission counseling by the health service (aOR: 5.08 [2.02–12.76]), or those who had a casual partner (aOR: 8.12 [1.7–38.8]) or a steady and casual one concomitantly (aOR: 24.82 [1.46–420.83]), were more likely to indicate an HIV serodiscordant partnership. Conclusion The findings showed a high prevalence of serodiscordant partnerships in PLHIV. Greater visibility among couples in the health services is needed as well as a reassessment in order to provide PLHIV and their sexual partners with care strategies, by the health professionals.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Serodiscordance predictors among couples in the HIV context: implications for health care

et al. 2021

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“…Responses are coded in this subcategory if they mention difficulties with condom use as a motivation to use PrEP [55].…”

Section: Difficulties With Condom Usementioning

confidence: 99%

“…By exploring the subjective experiences of MSM in their navigation of PrEP, these authors have identified, mostly through in-depth interviews or in focus groups, numerous and varied motivations for using (or not using) PrEP that call into question the usefulness of biomedical approaches to PrEP implementation that de-emphasise psychosocial phenomena. In many cases, the motivations identified in these studies have stemmed from powerful affective experiences, such as being freed from sometimes decades-long, often cyclical anxiety about HIV infection [ 37 , 38 , 54 , 55 ]; feeling empowered, able to make one’s own informed choices, in control or autonomous [ 37 , 56 ]; and feeling less fear and shame in relation to pre-existing high-risk sexual behaviours alongside greater sexual satisfaction and intimacy [ 57 , 58 ]. The qualitative literature also reports motivations related to fearing or experiencing PrEP-related stigma, such as beliefs that PrEP is only for those who are highly promiscuous [ 56 , 59 ]; being labelled a “Truvada whore” (or similar) in lesbian, gay, bisexual, transgender, intersex and other gender diverse (LGBTI+) media, or by peers or even friends [ 60 ]; encountering provider-level stigma, including judgemental behaviour about the decision to use PrEP [ 35 ]; or experiencing, as a PrEP user or non-user, increased pressure to engage in condomless anal intercourse [ 37 , 58 , 61 ].…”

Section: Introductionmentioning

confidence: 99%

Factors that motivate men who have sex with men in Berlin, Germany, to use or consider using HIV pre-exposure prophylaxis—A multi-methods analysis of data from a multicentre survey

et al. 2021

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Background While our knowledge of what motivates men who have sex with men (MSM) to use HIV pre-exposure prophylaxis (PrEP) has grown in recent years, quantitative survey-based studies have not asked MSM explicitly to name their motivations. We did so using a qualitative open-ended question and aimed to categorise the responses and explore whether these were related to where MSM were located along a conceptual continuum of PrEP care. Methods In a multicentre survey examining knowledge and use of PrEP among MSM in Berlin, Germany, we additionally asked an open-ended question about motivations for using or considering PrEP. Data were collected from 10/2017-04/2018. One researcher developed a thematic framework deductively from the literature and another did so inductively from the free-text data, and a merged framework was used to code responses independently. We used Fisher’s exact test to assess whether the frequency of motivations differed significantly between respondents using or considering PrEP. Results Of 875 questionnaires, 473 were returned and 228 contained a free-text response. Motivations in the following categories were reported: (1) Safety/protection against HIV (80.2% of participants, including general safety; additional protection to condoms), (2) Mental well-being and quality of life (23.5%, including reduced anxiety; better quality of life), (3) Condom attitudes (18.9% intent not to use condoms), (4) Expectations about sexuality (14.4%, including worry-free sex or more pleasurable sex, with explicit mention of sex or sexuality), (5) Norms/social perspectives (0.8%). The difference in frequencies of motivations between those using or considering PrEP was not statistically significant. Conclusions Safety and protection against HIV, particularly having additional protection if condoms fail, were the most common motivations for using or considering PrEP, followed by mental well-being and quality of life. Many respondents reported several motivations, and responses overall were heterogeneous. This suggests that approaches to increase PrEP uptake that focus exclusively on its effectiveness in preventing HIV are unlikely to be as successful as a holistic approach that emphasises multiple motivations and how these fit into the broader sexual and psychological health of MSM.

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Use of preexposure prophylaxis and condom purchasing decisions

Gebru,

Strickland,

Reed

et al. 2024

J Exper Analysis Behavior

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Preexposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) but not other sexually transmitted infections (STIs). Men who have sex with men (MSM) who take PrEP tend to report reduced condom use, but little is known about the underlying mechanisms. For this study, MSM who take PrEP (i.e., PrEP experienced; n = 88) and MSM who do not (i.e., PrEP naïve; n = 113) completed an online study, including the condom purchase task (CoPT). The CoPT assesses decisions to purchase condoms across escalating prices (range: free–$55) for sex with different types of hypothetical partners: those least likely to have an STD (least STD) and those that participants most want to have sex with (most want sex with). When condoms were free, PrEP‐experienced MSM had a lower rate of condom purchasing than did PrEP‐naïve MSM. For both partner types, PrEP‐experienced MSM reached a price break point (i.e., would not buy condoms) at a lower price than did PrEP‐naïve pariticipants. For the most‐want‐sex‐with partner at the price at which participants elected not to buy condoms, only 23% of PrEP‐experienced MSM chose to abstain from sex when not purchasing condoms versus 53% among PrEP‐naïve MSM. Similar patterns were observed for the least‐STD partner. The results support the potential utility of the CoPT in identifying behavioral mechanisms related to condom use and PrEP.

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“Now that PrEP is reducing the risk of transmission of HIV, why then do you still insist that we use condoms?” the condom quandary among PrEP users and health care providers in Kenya

Cited by 16 publications

References 55 publications

Serodiscordance predictors among couples in the HIV context: implications for health care

Serodiscordance predictors among couples in the HIV context: implications for health care

Factors that motivate men who have sex with men in Berlin, Germany, to use or consider using HIV pre-exposure prophylaxis—A multi-methods analysis of data from a multicentre survey

Use of preexposure prophylaxis and condom purchasing decisions

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