Navigating the ambiguities of pre-exposure prophylaxis for HIV prevention: insights from Zimbabwe and Denmark
1. Abstracts based on Formal Research WorkRufurwokuda Maswera2, Constance Nyamukapa2, 3, Simon Gregson2, 3
1 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
2 Manicaland Centre for Public Health Research, Biomedical Research and Training Institute, Harare, Zimbabwe
3 Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
Abstract
Background
Pre-exposure prophylaxis, or PrEP, has been shown to be effective in preventing the acquisition of HIV. Despite the promise and potential of PrEP, uptake has been limited, and many communities at elevated risk of HIV continue to have concerns about PrEP. This paper begins to disentangle some of the ambiguities that people on PrEP and potential PrEP users encounter, negotiate, and respond to in order to access and engage with PrEP.
Methodology
This study draws on Photovoice and interview data from 15 men who have sex with men in Denmark, and 20 adolescent girls and young women in Zimbabwe. Interviews and Photovoice stories were transcribed and thematically coded in NVivo 12, guided by the notion of ambiguity. Data was organized to detail meanings that were either opposing or could be understood in more than one way.
Results
We identify and detail five ambiguities that many people on PrEP and potential PrEP users must navigate to access and engage with PrEP. These include i) difficulties in reconciling the fact they are healthy, yet have to attend hospital appointments and take a daily pill; ii) social meanings associated with PrEP-use as being either a responsible or irresponsible act; iii) feelings of being protected against HIV, yet fear of being unprotected against other sexually transmitted infections; iv) perceptions of PrEP being an acceptable form of HIV prevention, yet invoke moralizing discourses and stigma around sexuality; v) feelings of sexual liberation, yet constrained by a treatment regiment and challenges to stop being on PrEP.
Conclusion
The ambiguities presented in this paper are both problematic and productive. They both haunt and energise, They are problematic because they prevent many people from accessing and engaging with PrEP. They haunt because of their reminiscence to many of the struggles sexual minorities and people in the global South have encountered since the dawn of the HIV epidemic. The ambivalences are productive in the sense that they point to public health action, including the importance of community mobilisation. They energise in the sense that the mental and practical work involved in accessing PrEP makes it an achievement, which sustains and motivates engagement.