Womens Sociocultural Representations of HIV Pre-Exposure Prophylaxis and Intimate Partner Violence in Heterosexual Relationships: A Qualitative Story Method

ObjectiveThe current study sought to assess womens understanding of pre-exposure prophylaxis interest and initiation in heterosexually-active relationships with and without histories of intimate partner violence. Design2017-18 prospective cohort study with an embedded, story completion exercise in the 90-day follow-up such that participants were randomized to receive one of two versions of a story stem based on whether they experienced intimate partner violence. SettingConnecticut. Participants132 heterosexually-active, cisgender adult women residing in the state of Connecticut. Primary outcomes measuresOur primary outcome included identifying principal narratives that describes womens conceptualizations of pre-exposure prophylaxis interest and initiation in heterosexually-active relationships. ResultsUsing both story mapping and thematic analysis techniques, four principal narratives were identified across the stories: 1) the Informed and Empowered PrEP User, 2) the Clandestine PrEP User, 3) the Hesitant PrEP Contemplator, and 4) the Disenfranchised PrEP Non-User. These novel narratives provide insights on how social, clinical, and interpersonal factors are underpinning heterosexually-active, cisgender adult womens ability to display interest and initiate pre-exposure prophylaxis in their relationships. ConclusionsIf our findings are replicated in studies in different settings, it will provide substantial support for future prevention interventions adopting empowerment-centered approaches to refocus womens needs in the context of PrEP initiation and healthy relationships.