The sexual risk context among the FEM-PrEP study population in Bondo, Kenya and Pretoria, South Africa.

Jennifer Headley,Meng Wang,Kawango Agot,Joseph Skhosana,Amy Corneli,Lut Van Damme,Jenae Tharaldson,Kathleen Macqueen,Jacob Odhiambo,Ansley Lemons,Khatija Ahmed,Alan Landay

doi:10.1371/journal.pone.0106410

Abstract

BackgroundIncidence rates in the FEM-PrEP and VOICE trials demonstrate that women from diverse sub-Saharan African communities continue to be at substantial HIV risk.ObjectiveTo describe and compare the sexual risk context of the study population from two FEM-PrEP trial sites–Bondo, Kenya, and Pretoria, South Africa.MethodsAt baseline we collected information about demographics, sexual behaviors, and partnership beliefs through quantitative questionnaires with all participants (Bondo, n = 720; Pretoria, n = 750). To explore the sexual risk context, we also conducted qualitative, semi-structured interviews with HIV-negative participants randomly selected at several time points (Bondo, n = 111; Pretoria, n = 69).ResultsDemographics, sexual behavior, and partnership beliefs varied significantly between the sites. Bondo participants were generally older, had fewer years of schooling, and were more likely to be employed and married compared to Pretoria participants. Bondo participants were more likely to report multiple partners and not knowing whether their partner had HIV than Pretoria participants. A significantly higher percentage of Bondo participants reported engaging in sex without a condom with their primary and other partners compared to Pretoria participants. We found a borderline association between participants who reported not using condoms in the 4 weeks prior to baseline and lower risk of HIV infection, and no association between having more than one sexual partner at baseline and HIV infection.DiscussionDespite significantly different demographics, sexual behaviors, and partnership beliefs, many women in the FEM-PrEP trial were at risk of acquiring HIV as demonstrated by the sites’ high HIV incidence. Though gender dynamics differed between the populations, they appear to play a critical role in women’s sexual practices. The findings highlight different ways women from diverse contexts may be at-risk for HIV and the importance of providing HIV prevention options that are both effective and feasible given personal and social circumstances.

Highlights

Breakthroughs in the field of HIV prevention have identified encouraging approaches to substantially reduce the number of new infections
Despite significantly different demographics, sexual behaviors, and partnership beliefs, many women in the FEM-pre-exposure prophylaxis (PrEP) trial were at risk of acquiring HIV as demonstrated by the sites’ high HIV incidence
We provide a descriptive analysis of sexual behaviors, risk characteristics, and partnership beliefs of the study population from two FEM-PrEP sites – Bondo, Kenya, and Pretoria, South Africa

Summary

Introduction

Breakthroughs in the field of HIV prevention have identified encouraging approaches to substantially reduce the number of new infections. Interventions to modify sexual risk factors are not always sufficient, when focused on changing individual behaviors that do not account for structural barriers, the broader social environment, or the gender identities from which sexual behaviors stem [17,18,19,20] New prevention technologies, such as PrEP, which may not be reliant on male partner participation, can provide women an option for protection within these contextual constraints and may be effective in altering the course of the epidemic, when paired alongside broader interventions [11,21]. Incidence rates in the FEM-PrEP and VOICE trials demonstrate that women from diverse sub-Saharan African communities continue to be at substantial HIV risk

Methods

Results

Conclusion