P46.01
Background: Our previous survey research on pre-exposure prophylaxis (PrEP) and risk compensation with women at HIV risk in Bondo, Kenya, and Soshanguve, South Africa, showed that a considerable minority of women may engage in riskier sexual behavior if taking PrEP. We conducted a small qualitative study to explore perceptions of an informed-choice approach to PrEP counseling. This approach promotes condoms but empowers women who are unable or unwilling to use condoms to make informed decisions regarding their sexual health when taking PrEP.
Methods: We conducted eight focus groups with women in Bondo and Soshanguve (four per site). We introduced the counseling approach and presented participants with multiple messages on PrEP and on risk compensation when using PrEP, with some concepts framed as gain versus loss. Responses were coded on aspects of the messages that were perceived to be effective and ineffective and on perceptions of the counseling. Themes were identified and summarized.
Results: Preliminary analysis suggests that participants appreciated the counseling's autonomy framework and believed messages on risk compensation would be understood by women in their communities. Participants generally liked the positive tone of the gain-frame messages and found them polite and encouraging. The loss-frame messages were viewed as harsh and threatening, but powerful. Many believed these messages' cautionary tone and description of consequences would more effectively influence women's behavior, primarily in Soshanguve. In Bondo, many participants preferred the softer gain-frame messages and described clarity and comprehension as critical aspects of messaging.
Conclusions: Both gain- and loss-frame messages were generally understood, although variation existed in their acceptability and perceived influence. Research among actual PrEP users is needed to understand the effectiveness of message framing and of the informed-choice counseling approach, particularly in African contexts.
