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


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  


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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