OA15.05
Background: Now that Truvada as pre-exposure prophylaxis (PrEP) has been shown to be effective, critical questions about implementation center on when individuals should take PrEP and for how long. Periods of PrEP use, suggested to correspond with periods of increased HIV risk, have been termed seasons of PrEP. Understanding when and why women would suspend PrEP use is essential for effective counseling on initiating and stopping PrEP. We explored how African women at higher risk of HIV might define the end of a season of PrEP, to help inform counseling guidelines.
Methods: As part of a larger study exploring PrEP and risk compensation among women at higher risk of HIV in Bondo, Kenya, and Soshanguve, South Africa, we conducted qualitative semi-structured interviews with 30 women from each site. Participants created timelines of their sexual contacts over the past six months and were asked to imagine they had taken PrEP during this period. Referencing their timelines, the women discussed whether and why they would have taken a break from PrEP, or would do so in the future.
Results: A third of the women reported they would have suspended their use of PrEP during the past six months. Nearly half foresaw a reason to suspend PrEP use in the future, citing reasons related to partnership issues, phases of life, and life events. Partnership issues ranged from no current partner to concepts of trust and stability in relationships. Phases of life included pregnancy and aging out of frequent sex. Life events focused on extended travel or festive seasons that could disrupt PrEP use. In some of these contexts, suspension of PrEP was related to a perceived reduction in HIV risk. In others, the potential for risk stayed the same or increased.
Conclusions: Women recognize circumstances, separate from daily adherence issues, in which they will stop PrEP. These may or may not correspond to lower risk contexts. Counseling is needed when women transition off PrEP to discuss risk and strategies for maintaining sexual health.
