Motivations and barriers to uptake and use of female-initiated, biomedical HIV prevention products in sub-Saharan Africa: an adapted meta-ethnography

BMC Public Health

Research Article

Adam Bourne¹  Heidi Larson²  Caitlin Jarrett³  Jonathan Stadler⁴  Robyn Eakle⁵ 

[1] Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK;Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland;University of Basel, Basel, Switzerland;Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Hillbrow Health Precinct, 22 Esselen Street, Hillbrow, 2001, Johannesburg, South Africa;Department of Anthropology and Development Studies, University of Johannesburg, Johannesburg, South Africa;Wits Reproductive Health & HIV Institute, University of the Witwatersrand, Hillbrow Health Precinct, 22 Esselen Street, Hillbrow, 2001, Johannesburg, South Africa;Department of Social and Environmental Health Research, Sigma Research, London School of Hygiene and Tropical Medicine, London, UK;

关键词: HIV prevention;    Biomedical prevention products;    Pre-exposure prophylaxis (PrEP);    Women;    Qualitative research;   

DOI  :  10.1186/s12889-017-4959-3

 received in 2016-10-12, accepted in 2017-11-29,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWomen bear a disproportionate burden of HIV throughout the world prompting extensive research into HIV prevention products for women which has met with varied success. With an aim of informing future policy and programming, this review examines the barriers and motivations to the uptake and use of female initiated products in sub-Saharan countries.MethodsWe conducted a systematic review as an adapted meta-ethnography of qualitative data focused on actual use of products. After deduplication, 10,581 and 3861 papers in the first and second round respectively were screened. Following the PRISMA guidance, 22 papers were selected and synthesized using Malpass’s definitions of first, second, and third order constructs. First order constructs, consisting of participant data published in the selected papers, were extracted and categorised by second and third order constructs for analysis. A weight of evidence review was conducted to compare and assess quality across the papers.ResultsThe 22 papers selected span 11 studies in 13 countries. We derived 23 s order constructs that were translated into seven overarching third order constructs: Sexual Satisfaction, Trust, Empowerment and Control, Personal Well-being, Product use in the social-cultural environment, Practical Considerations, Risk Reduction, and Perceptions of Efficacy. Relationships and trust were seen to be as or more important for product use as efficacy. These constructs reveal an inherent inter-relationality where decision making around HIV prevention uptake and use cannot be binary or mono-faceted, but rather conducted on multiple levels. We developed a framework illustrating the central and proximal natures of constructs as they relate to the decision-making process surrounding the use of prevention products.ConclusionsHealth systems, structural, and individual level HIV prevention interventions for women should adopt a holistic approach. Interventions should attend to the ways in which HIV prevention products can serve to reduce the likelihood of HIV transmission, as well as help to protect partnerships, enhance sexual pleasure, and take into account woman’s roles in the social environment. Stigma, as well as sexuality, is likely to continue to influence product uptake and use and should be prominently taken into account in large-scale interventions.Trial registrationNot applicable.

【 授权许可】

CC BY   
© The Author(s). 2017