Discordant relationships always offer a gender problem, women and other people with gender orientation live the difficulty in negotiating the use of condoms "
Non-HIV-positive women in serodiscordant HIV relationships are less likely to take PrEP consistently if they experience intimate partner violence
Posted in: 20 June 2016
Coping with violence in intimate relationships is associated with an increased risk of poor adherence to pre-exposure prophylaxis (PrEP) among women in serodiscordant relationships in sub-Saharan Africa, according to the online edition of Journal of Acquired Immunodeficiency Syndromes.
Overall, 16% of women who experienced intimate partner violence (IPV) had suboptimal adherence to PrEP around 50%, when adherence is assessed by either method of pill counts or plasma concentrations of tenofovir.
PrEP has been used 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 therefore recommend PrEP as part of comprehensive HIV prevention programs targeted at high-risk populations.
The efficacy of PrEP is related to adhesion. Violence in intimate relationships has been associated with a higher incidence of HIV, by reducing the use of condoms and suboptimal adherence to antiretroviral therapy. It is therefore possible that violence in intimate relationships may also affect adherence to PrEP.
Partner researchers in recent PrEP studies analyzed the data obtained from 1785 HIV-negative women in the serodiscordant relationships included in the study. In monthly face-to-face interviews, women were asked to report their experiences of verbal, physical, or economic behavior in the face of intimate partner violence.
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 and 70% had earned an income in the previous three months. The vast majority (99%) were married. The mean duration of the relationship was 13 years and women had declared themselves in serodiscordant relationships at an average of 1,4 years.
During 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 violence.
Women reporting intimate partner violence last month were less likely to report abuse than women who reported having sex had not had sex with any partner in their comparative study of recent partners (69% versus 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 intimate partner violence were similar in most respects to women who did not report partner violence.
Adherence assessed by pill counts was high (95%) among most women, regardless of reported intimate partner violence. The counting of pills suggested adherence below 80% to 7% of study visits and 32% of plasma tenofovir measurements were below optimal levels.
Overall, 50% women were more likely to have inadequate adherence to PrEP if they had experienced intimate relationship violence in the previous three months. This association was consistent regardless of whether adherence was measured by pill counts (RAR, 1,51, 95%, 1,17-1,89, p = 0,001) or plasma concentrations of tenofovir (RAR, 1,51, IC 95%, 1,06- 2,15, 0,02).
However, the impact of violence on intimate relations on membership is no longer significant after three months.
When "types" of intimate partner violence were considered separately, researchers found a significant relationship between inadequate adherence and verbal abuse (RAR = 1,65, 95%, 1,17-2,33, p = 0,005) and low adherence when abuse of power (RAR = 1,48, IC 95%, 1,14-1,92, p = 0,003). The relationship between low adherence and physically violent partner was not significant, but the greater frequency of physical abuse of a partner was associated with a 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 retrieve pills that had been thrown away, or explaining events to the clinical staff, who were able to offer replacement therapy.
"Efforts to guide 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 adherence to IPV and the lessons from 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. "
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 study. J Acquire Aõâ Defic Synr immune, online edition. DOI: 10.1097 / QAI.0000000000001093, 2016.