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‘This is mine, this is for me’

preexposure prophylaxis as a source of resilience among women in Eswatini

Bärnighausen, Kate E.a,b; Matse, Sindyc; Kennedy, Caitlin E.d; Lejeune, Charlotte L.e; Hughey, Allison B.e; Hettema, Anitae; Bärnighausen, Till W.a,f; McMahon, Shannon A.a,d

doi: 10.1097/QAD.0000000000002178
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Objective: To understand the relationship between HIV preexposure prophylaxis (PrEP) and resilience among Emaswati women.

Design: A qualitative study using semistructured in-depth interviews.

Methods: We interviewed 24 women who recently initiated PrEP at one of six public-sector primary-care clinics participating in a government demonstration project for PrEP for the general population, as well as 30 PrEP stakeholders from HIV policy, implementation and donor sectors.

Results: PrEP clients and stakeholders described an environment marked by high HIV risk. In this context, clients felt PrEP enhanced their resilience through feelings of protection, control over HIV acquisition, choice in relation to when to take PrEP, sexual pleasure and relief from the fear and consequences of HIV infection. Those in serodiscordant relationships described improved partner communication and a shared sense of responsibility for HIV prevention. Both PrEP clients and stakeholders asserted that PrEP marketing and communication should be Emaswati-led and community-owned.

Conclusion: PrEP helps women in Eswatini envision longer, healthier and more fulfilled lives. PrEP enhances resilience through several pathways, including self-efficacy, choice, control over HIV infection and relief from the fear of HIV infection. Social marketing and information campaigns should not only focus on PrEP as an HIV-prevention method but also emphasize how PrEP has expanded choice, enhanced control and facilitated sexual enjoyment among PrEP clients.

aFaculty of Medicine, Institute for Global Health, University of Heidelberg, Heidelberg, Germany

bUniversity of the Witwatersrand School of Public Health, Johannesburg, South Africa

cEswatini Ministry of Health, Mbabane, Eswatini

dDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

eClinton Health Access Initiative Eswatini, Mbabane, Eswatini

fDepartment of Global Health and Population, Harvard T.H. Chang School of Public Health, Boston, Massachusetts, USA.

Correspondence to Kate E. Bärnighausen, Faculty of Medicine, Institute for Global Health, University of Heidelberg, Heidelberg, Germany. E-mail: kate.baernighausen@uni-heidelberg.de

Received 21 March, 2018

Revised 29 October, 2018

Accepted 4 February, 2019

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Copyright © 2019 Wolters Kluwer Health, Inc.