The Promise and Peril of Pre-Exposure Prophylaxis (PrEP): Using Social Science to Inform PrEP Interventions among Female Sex Workers

Jennifer L. Syvertsen, Angela M. Robertson Bazzi, Andrew Scheibe, Sylvia Adebajo, Steffanie A. Strathdee, Wendee M. Wechsberg

Abstract

Advances in biomedical interventions to prevent HIV offer great promise in reducing the number of new infections across subSaharan Africa, particularly among vulnerable populations such as female sex workers. Several recent trials testing pre-exposure prophylaxis (PrEP) have demonstrated efficacy, although others have been stopped early for futility. Given the importance and complexities of social and behavioural factors that influence biomedical approaches to prevention, we discuss several key areas of consideration moving forward, including trial participation, adherence strategies, social relationships, and the structural factors that shape PrEP interest, use, and potential effectiveness among female sex workers in sub-Saharan Africa. Our review highlights the importance of involving social scientists in clinical and community-based research on PrEP. We advocate for a shift away from a singular “re-medicalization” of the HIV epidemic to that of a “reintegration” of interdisciplinary approaches to prevention that could benefit female sex workers and other key populations at risk of acquiring HIV.  (Afr J Reprod Health 2014; 18[3]: 7483)

 

Keywords (3-6): biomedical interventions, social science, qualitative and ethnographic research, sub-Saharan Africa  

Résumé 

Les progrès dans les interventions biomédicales de la prévention du VIH sont très prometteurs pour réduire le nombre de nouvelles infections en Afrique sub-saharienne, surtout parmi les populations vulnérables comme les prostituées. Plusieurs tests d'essais récents de la prophylaxie de la pré-exposition (PPrE) ont démontré l'efficacité, bien que d'autres ont été arrêtés tôt pour la futilité. Etant donné  l'importance et  la complexité des facteurs sociaux et comportementaux qui influent sur les approches biomédicales de la prévention, nous discutons plusieurs secteurs clés d'évaluation allant de l'avant, y compris la participation aux essais, les stratégies d'adhésion, les relations sociales, et les facteurs structurels qui forment  l'intérêt PPrE, l'utilisation et le potentiel efficacité chez les prostituées en Afrique sub-saharienne. Notre étude fait ressortir l'importance de la participation des spécialistes des sciences sociales dans la recherche clinique et communautaire sur la PPrE. Nous plaidons pour un passage d'une seule «ré-médicalisation»  de l'épidémie du VIH à celle d'une «réintégration» des approches interdisciplinaires à la prévention qui pourraient bénéficier aux prostituées et aux autres populations clés à risque de contracter le VIH. Afr J Reprod Health 2014; 18[3]: 74-83)

 

Mots-clés: Interventions biomédicales,  sciences sociales,  recherche qualitative et ethnographique, Afrique sub-saharienne

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References

Beyrer C, Crago AL, Bekker LG, et al. An action agenda for HIV and sex workers. The Lancet 2014; doi:10.1016/S0140-6736(14)60933-8.

Camlin CS, Kwena ZA, Dworkin SL. Jaboya vs. jakambi: Status, negotiation, and HIV risks among female migrants in the" sex for fish" economy in Nyanza Province, Kenya. AIDS education and prevention 2013;25:216-31.

Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo Y-R. Socio-demographic characteristics and behavioral risk factors of female sex workers in subSaharan Africa: a systematic review. AIDS and Behavior 2012;16:920-33.

Eluwa GI, Strathdee SA, Adebajo SB, Ahonsi B, Azeez A, Anyanti J. Sexual risk behaviors and HIV among female sex workers in Nigeria. JAIDS Journal of

Acquired Immune Deficiency Syndromes

;61:507-14.

Wechsberg WM, Luseno WK, Lam W. Violence against substance-abusing South African sex workers: intersection with culture and HIV risk. AIDS care 2005;17:55-64.

Stoebenau K, Hindin MJ, Nathanson CA, Rakotoarison

PG, Razafintsalama V. "... But Then He Became My

Sipa": The Implications of Relationship Fluidity for

Condom Use Among Women Sex Workers in Antananarivo, Madagascar. American Journal of Public Health 2009;99:811-9.

Robertson AM, Syvertsen JL, Amaro H, et al. Can't Buy My Love: A Typology of Female Sex Workers' Commercial Relationships in the Mexico–US Border Region. Journal of Sex Research 2013;51:1-10.

Scheibe A, Drame FM, Shannon K. HIV prevention among female sex workers in Africa. SAHARA-J: Journal of Social Aspects of HIV/AIDS 2012;9:16772.

Shannon K, Goldenberg SM, Deering KN, Strathdee SA. HIV infection among female sex workers in concentrated and high prevalence epidemics: why a structural determinants framework is needed. Current Opinion in HIV and AIDS 2014;9:174-182.

Shannon K, Strathdee SA, Goldenberg SM, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. 2014; http://dx.doi.org/10.1016/S0140-6736(14)60931-4.

Scorgie F, Vasey K, Harper E, et al. Human rights abuses and collective resilience among sex workers in four African countries: a qualitative study. Globalization and Health 2013;9:33.

Abdool Karim Q, Humphries H, Stein Z. Empowering women in human immunodeficiency virus prevention. Best Practice & Research Clinical Obstetrics & Gynaecology 2012;26:487-93.

Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and Safety of Tenofovir Gel, an Antiretroviral Microbicide, for the Prevention of HIV Infection in Women. Science 2010;329:1168-74.

Baeten JM, Donnell D, Ndase P, et al. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men

and Women. New England Journal of Medicine 2012;367:399-410.

Thigpen MC, Kebaabetswe PM, Paxton LA, et al. Antiretroviral Preexposure Prophylaxis for Heterosexual HIV Transmission in Botswana. New England Journal of Medicine 2012;367:423-34.

Van Damme L, Corneli A, Ahmed K, et al. Preexposure Prophylaxis for HIV Infection among African Women. New England Journal of Medicine

;367:411-22.

National Institute of Allergy and Infectious Diseases (NIAID). NIH modifies ‘VOICE’ HIV prevention study in women. 2011; http://wwwnihgov/ news/health/sep2011/niaid-28htm.

Cohen MS, Baden LR. Preexposure Prophylaxis for HIV

— Where Do We Go from Here? New England

Journal of Medicine 2012;367:459-61.

Baeten J, Celum C. Systemic and topical drugs for the prevention of HIV infection: antiretroviral preexposure prophylaxis. Annual Review of Medicine 2013;64:219.

Strathdee SA, Wechsberg WM, Kerrigan DL, Patterson TL. HIV prevention among women in low-and middle-income countries: Intervening upon contexts of heightened HIV risk. Annual Review of Public Health 2013;34:301-16.

Page JB. Shooting Scenarios and Risk of HIV-1 Infection. American Behavioral Scientist 1990;33:478-90.

Koester S, Booth R, Wiebel W. The risk of HIV transmission from sharing water, drug mixing containers and cotton filters among intravenous drug users. International Journal of Drug Policy 1990;1:2830.

Inciardi JA, Lockwood D, Pottieger AE. Women and Crack Cocaine. New York: Macmillan Publishing Company; 1993.

Schoep BG. International AIDS research in anthropology: taking a critical perspective on the crisis. Annual Review in Anthropology 2001;30:335-61.

Nguyen V-K, O’Malley J, Pirkle CM. Remedicalizing an epidemic: from HIV treatment as prevention to HIV treatment is prevention. AIDS 2011;25:1435.

Van der Straten A, Stadler J, Montgomery E, et al.

Women’s Experiences with Oral and Vaginal PreExposure Prophylaxis: The VOICE-C Qualitative Study in Johannesburg, South Africa. PloS One 2014;9:e89118.

MacQueen KM. Framing the social in biomedical HIV prevention trials: a 20-year retrospective. Journal of the International AIDS Society 2011;14(Suppl 2):S3.

Montgomery CM, Pool R. Critically engaging: integrating the social and the biomedical in international microbicides research. Journal of the International AIDS Society 2011;14(Suppl 2):S4.

Lagakos SW, Gable AR. Methodological challenges in biomedical HIV prevention trials. Washington DC: National Academies Press; 2008.

Pool R, Montgomery CM, Morar NS, et al. A mixed methods and triangulation model for increasing the

accuracy of adherence and sexual behaviour data: the Microbicides Development Programme. PloS One 2010;5:e11600.

Pool R, Montgomery CM, Morar NS, et al. Assessing the accuracy of adherence and sexual behaviour data in the MDP301 vaginal microbicides trial using a mixed methods and triangulation model. PloS One 2010;5:e11632.

Montgomery CM, Lees S, Stadler J, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care

;20:733 - 40.

Woodsong C, Alleman P, Musara P, et al. Preventive misconception as a motivation for participation and adherence in microbicide trials: evidence from female participants and male partners in Malawi and Zimbabwe. AIDS and Behavior 2012;16:785-90.

Rhodes T, Wagner K, Strathdee S, Shannon K, Davidson P, Bourgois P. Structural Violence and Structural Vulnerability Within the Risk Environment: Theoretical and Methodological Perspectives for a Social Epidemiology of HIV Risk Among Injection Drug Users and Sex Workers. In: O’Campo P, Dunn JR, eds. Rethinking Social Epidemiology: Springer Netherlands; 2012:205-30.

Van Damme L, Corneli A, Ahmed K, et al. Preexposure prophylaxis for HIV infection among African women. The New England Journal of Medicine 2012;367:41122.

Mutua G, Sanders E, Mugo P, et al. Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers. PLoS One 2012;7:e33103.

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.

Robertson AM, Syvertsen JL, Martinez G, et al. Acceptability of vaginal microbicides among female sex workers and their intimate male partners in two Mexico–US border cities: A mixed methods analysis. Global public health 2013;8:619-33.

Ye L, Wei S, Zou Y, et al. HIV Pre-Exposure Prophylaxis Interest among Female Sex Workers in Guangxi, China. PloS one 2014;9:e86200.

Stadler J, Saethre E. Rumours about blood and reimbursements in a microbicide gel trial. African Journal of AIDS Research 2010;9:345-53.

Haire BG. Because we can: clashes of perspective over researcher obligation in the failed PrEP trials. Developing World Bioethics 2011;11:63-74.

Jürgens R. "Nothing about us without us." Greater, Meaningful Involvement of People Who Use Illegal Drugs: A Public Health, Ethical, and Human Rights Imperative. Toronto: Canadian HIV/AIDS Legal Network, International HIV/AIDS Alliance, Open Society Institute; 2008.

Overs C, Loff B. The tide cannot be turned without us: sex workers and the global response to HIV. Journal of the International AIDS Society 2013;16:18459.

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-F9.

Amico KR, Mansoor L, Corneli A, Torjesen K, Straten A. Adherence Support Approaches in Biomedical HIV Prevention Trials: Experiences, Insights and Future Directions from Four Multisite Prevention Trials. AIDS and Behavior 2013:1-13.

Elst E, Mbogua J, Operario D, 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 and Behavior

;17:2162-72.

Mansoor L, Abdool Karim Q, Yende-Zuma N, et al.

Adherence in the CAPRISA 004 Tenofovir Gel Microbicide Trial. AIDS and Behavior 2014:1-9.

Woodsong C, MacQueen K, Amico KR, et al.

Microbicide clinical trial adherence: insights for introduction. Journal of the International AIDS Society 2013;16.

Greene E, Batona G, Hallad J, Johnson S, Neema S, Tolley EE. Acceptability and adherence of a candidate microbicide gel among high-risk women in Africa and India. Culture, Health & Sexuality 2010;12:739-54.

Montgomery ET, van der Straten A, Chidanyika A, Chipato T, Jaffar S, Padian N. The importance of male partner involvement for women’s acceptability and adherence to female-initiated HIV prevention methods in Zimbabwe. AIDS and Behavior 2011;15:959-69.

Woodsong C, Alleman P. Sexual Pleasure, Gender Power and Microbicide Acceptability in Zimbabwe and Malawi. AIDS Education and Prevention

;20:171-87.

Gorbach P, Kelly C, Borgerding J, et al. Effects of Partnership Change on Microbicide Gel Adherence in a Clinical Trial (HPTN 035). AIDS and Behavior 2013:1-7.

Mngadi KT, Maarschalk S, Grobler AC, et al. Disclosure of microbicide gel use to sexual partners: influence on adherence in the CAPRISA 004 trial. AIDS and Behavior 2014:1-6.

Ware NC, Wyatt MA, Haberer JE, et al. What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis (PrEP) for HIV serodiscordant couples. Journal of Acquired Immune Deficiency Syndromes 2012;59:463-468.

Stadler J, Delany-Moretlwe S, Palanee T, Rees H. Hidden harms: women’s narratives of intimate partner violence in a microbicide trial, South Africa. Social Science & Medicine 2014; 110:49-55.

Panchanadeswaran S, Johnson SC, Sivaram S, et al. Intimate partner violence is as important as client violence in increasing street-based female sex workers' vulnerability to HIV in India. International Journal of Drug Policy 2008;19:106-12.

Romero-Daza N, Weeks M, Singer M. Conceptualizing the impact of indirect violence on HIV risk among women involved in street-level prostitution. Aggression and Violent Behavior 2005;10:153-70.

El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female streetbased sex workers: substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care and STDs 2001;15:41-51.

Romero-Daza N. Multiple sexual partners migrant labor and the makings for an epidemic: knowledge and beliefs about AIDS among women in highland Lesotho. Human Organization 1994;53:192-205.

Li Q, Li X, Stanton B. Alcohol use among female sex workers and male clients: an integrative review of global literature. Alcohol and Alcoholism 2010;45:188-99.

Chersich M, Luchters S, Malonza I, Mwarogo P, King'Ola N, Temmerman M. Heavy episodic drinking among Kenyan female sex workers is associated with unsafe sex, sexual violence and sexually transmitted infections. International Journal of STD & AIDS 2007;18:764-9.

Beckerleg S, Hundt GL. Women heroin users: Exploring the limitations of the structural violence approach.

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