Feminization of the epidemic June 2016 Women and AIDS PREP Violence against Women

Women in serodiscordant relationships for HIV are less likely to take PrEP consistently if they experience violence in intimate relationships

Coping with intimate partner violence is associated with an increased risk of poor adherence to pre-exposure prophylaxis (PrEP) among women in serodiscordant relationships in sub-Saharan Africa, this is in the online edition of Journal of Acquired Immunodeficiency Syndrome. Overall, 16% of women who have experienced intimate partner violence (IPV) and this determined a use sub-optimal PrEP grip around 50%, when adhesion is evaluated by any method of counting pills or plasma concentrations of tenofovir .

"This is the first study to examine the association between IPV and PrEP adherence, the authors write. "Women who reported IPV last 3 months had an increased risk of low adherence PrEP."

PrEP has been shown to reduce the risk of infection with HIV in a variety of populations, including gay men, heterosexual men and women and injecting drug users. We recommend, therefore PrEP as part of comprehensive HIV prevention programs aimed at high-risk populations.

The efficacy of PrEP is related to accession. Violence in intimate relationships has been linked to a higher incidence of HIV, reduced the use of condoms and suboptimal adherence to antiretroviral therapy. It is therefore possible that violence in intimate relationships can also affect adherence to PrEP.

Recent researchers Partners in PrEP study therefore analyzed data obtained from 1785 HIV negative women in serodiscordant relationships included in the study. face to face monthly interviews, women were asked to report their experiences of verbal behavior, physical or economic in the face of violence in intimate relationships.

The researchers evaluated the relationship between partner abuse and suboptimal adherence to PrEP. Two measures were used to assess adherence: pill counts (less than 80% of the doses define low compliance) and measurement of plasma levels of tenofovir (low adherence defined as levels below 40 ng / ml). In-depth interviews with a subset of women from insights on how intimate-relations violence has affected adherence and individual intent to maintain PReP, as well as the strategies used to maintain adherence to PrEP in the context of "violent relationships."

Participants had a mean age of 33 years 70% had obtained an income in the last three months prior. The vast majority (99%) were married. The average relationship duration was 13 years and women had declared in serodiscordant relationships in an average of 1,4 years.

Truvada-300x202During 35 months of follow-up, 288 women (16%) reported violence in intimate relationships in 437 study visits (0,7% of total). Of these women, 69% reported violence in intimate relationships on one visit, 20% on two visits, 7% on three visits, and 5% on four or more visits. The most common form of violence in intimate relationships reported was verbal, followed by physical and economic. Women reporting intimate partner violence last month were less likely to report abuse than women reporting abuse who had sex had had sex with any partner in their comparative study of recent partners (69% vs. 81%), but more likely linked to the unprotected sexual activity report (22% vs. 13%). They were also the most reported to have had sex with partners who reported sex with another partner (20% versus 15%).

These reports of violence in intimate relationships were similar in most respects to women who did not report the respective partner violence.

The adherence assessed by pill count was high (95%) among most women, regardless of reported violence in intimate relationships. The pill counts suggested the membership below 80% to 7% of study visits and 32% of tenofovir plasma measurements were below optimal levels.

In general, women were 50% more likely to have inadequate adherence to PrEP had experienced violence in intimate relationships in the previous three months. This association was consistent regardless of membership be measured by pill count (RAR, 1,51 CI 95%, 1,17-1,89, p = 0,001) or plasma concentrations of tenofovir (RAR, 1,51 CI 95%, 1,06-2,15, p = 0,02).

However, the impact of violence in intimate relationships on the accession was no longer significant after three months.


When "types" of violence in intimate relationships were considered separately, the researchers found a significant relationship between inadequate adhesion and verbal abuse (ARR = 1,65 CI 95%, 1,17-2,33, p = 0,005) and low grip when there was abuse of power economic by the partner who committed violence (ARR = 1,48, 95% CI, 1,14-1,92, p = 0,003). The relationship between low adherence and physically violent partner was not significant, but the higher frequency of physical abuse of a partner was associated with lower adherence to treatment (p <0,001).

There was a total of 48 new HIV infections among women. However, living under violence in intimate relationships did not significantly increase the risk of seroconversion. Seven women discussed intimate relationship violence during in-depth interviews with staff. Reasons for the form of abuse on the part of covered partners affected adherence included stress and forgetfulness, daily running routine, skip doses and medication partners wasting medications.

Strategies to overcome these challenges and maintain high adherence include sending children to recover pills that had been thrown away, or explain events to the clinic staff, who were able to offer replacement therapy.

"Efforts to target women with IPV PrEP should recognize the low risk of adherence, and interventions should be evaluated to promote adherence to PrEP in the context of violence, the authors conclude. "Some women in our study reported strategies to maintain grip in the face of IPV and the lessons these examples of resilience could help in the development of successful interventions. Such interventions could increase the benefit of PrEP by promoting effective use in a population at high risk for HIV infection. "

Michael Carter
Published: June 20 2016

Translated by Original Claudio Souza in Women in HIV serodiscordant relationships less Likely to take PrEP consistently If They experience intimate partner violence. Reviewed by Mara Macedo.


Roberts ST et al. Violence in intimate relationships and adherence to pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: a prospective cohort. J Adquiriraâ AOA Defic immune Synr, online edition. DOI: 10.1097 / QAI.0000000000001093, 2016.

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