The lived experiences of young women on the use of HIV pre-exposure prophylaxis in Namibia

Date
2021-12
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY : Background: Young women have a higher risk of acquiring HIV than other population groups. In sub-Saharan African, at least five in six new HIV infections happen in girls between the ages of 15-19 years. This age group is particularly at a high risk of acquiring HIV due to issues affecting young women such as gender based violence, sexual abuse, limited access to education and health services, and inequalities and injustice. Pre-exposure prophylaxis (PrEP) is the use of antiretroviral medicines by HIV negative individuals before HIV exposure to avert HIV infection. However, since its introduction in Namibia, in 2016, PrEP uptake amongst young women remains low. Various conditions may influence women‟s decisions to initiate and continue PrEP. Little is known about the lived experiences of young women on the use of PrEP. Aim and objectives: The aim of the study was to explore the lived experiences of young women on the use of PrEP in Namibia. The objectives were to: - explore the knowledge and understanding of young women about PrEP, - describe the socio-cultural, educational and informational conditions that influenced their decision to use PrEP, - describe the physical, emotional and social support needs of young women using PrEP. Methods: A qualitative descriptive phenomenological design was used. The study inclusion criteria were: young women aged between 21 and 24 years; current or previous use of PrEP; and attendance of at least one follow-up visit after commencing PrEP. The sample included nine participants from five clinics in and around the town of Rundu, in the Rundu district of the Kavango East region of Namibia. A purposive sampling method was used to obtain maximum variability. Data collection involved face-to-face in-depth interviews using a semi-structured interview guide. Colaizzi’s seven-step process was used to analyse data. Ethics approval was obtained from the Stellenbosch University Health Research Ethics Committee reference number, S19/02/031. Furthermore permission was obtained from the Ministry of Health and Social Services and the regional health director of Kavango East region. Findings: Three themes were identified: risk awareness, empowered for self-care, and persisting despite the challenges. Young women in this study were aware of their risk of acquiring HIV and this prompted them to use PrEP. These risks included lack of awareness of their partne’s HIV status coupled with a lack of trust in their partners; or being in a sexual relationship with a partner living with HIV. Awareness also emanated from information provided by healthcare workers, peers and the media. Using PrEP empowered young women for self-care through enabling them to make choices about managing their risk. Some of the women persisted using PrEP despite several challenges which included the lack of privacy, stigma and inadequate support. Conclusion and recommendations: PrEP is an empowering HIV prevention strategy for young women, however, much still needs to be done to promote young women‟s willingness to initiate and continue PrEP. PrEP awareness campaigns should be expanded to address myths and misconceptions and positively influence social norms. Differentiated PrEP delivery models should be implemented, including integration with other services such as sexual reproductive health services, effective counselling and peer support.
AFRIKAANSE OPSOMMING : Agtergrond: Jong vroue het 'n hoër risiko om MIV op te doen as ander bevolkingsgroepe. In Afrika suid van die Sahara kom minstens vyf uit ses nuwe MIV-infeksies voor by meisies tussen die ouderdom van 15 en 19 jaar. Hierdie ouderdomsgroep loop veral 'n hoë risiko om MIV te kry as gevolg van kwessies wat jong vroue raak, soos geslagsgeweld, seksuele misbruik, beperkte toegang tot onderwys- en gesondheidsdienste, en ongelykhede en onreg. Pre-blootstelling profylakse (PrEP) is die gebruik van antiretrovirale medisyne deur MIV-negatiewe individue voordat MIV blootgestel word aan MIV-infeksie. Sedert sy bekendstelling in Namibië in 2016, is die opname van PrEP onder jong vroue egter steeds laag. Verskeie toestande kan vroue se besluite beïnvloed om PrEP te inisieer en voort te sit. Weinig is bekend oor die ervarings wat jong vroue met PrEP gebruik het. Doel en doelstellings: Die doel van die studie was om die ervarings van jong vroue oor die gebruik van PrEP in Namibië te ondersoek. Die doelstellings was om: - die kennis en begrip van jong vroue oor PrEP, - die sosio-kulturele, opvoedkundige en inligtingstoestande wat hul besluit om PrEP te gebruik, beïnvloed, - die fisiese, emosionele en sosiale ondersteuningsbehoeftes van jong vroue met behulp van PrEP te beskryf. Metodes: 'N Kwalitatiewe beskrywende fenomenologiese ontwerp is gebruik. Die kriteria vir die insluiting van die studie was: jong vroue tussen 21 en 24 jaar; huidige of vorige gebruik van PrEP; en bywoning van ten minste een opvolgbesoek na aanvang van PrEP. Die steekproef het nege deelnemers van vyf klinieke in en rondom die stad Rundu, in die Rundu-distrik van die Kavango-Oos-streek van Namibië, ingesluit. 'N Doelgerigte steekproefmetode is gebruik om maksimum wisselvalligheid te verkry. Die insameling van data het van diepgaande onderhoude van aangesig tot aangesig gebruik gemaak van 'n semi-gestruktureerde onderhoudsgids. Colaizzi se sewe-stap-proses is gebruik om data te ontleed. Etiese goedkeuring is verkry vanaf die Universiteit Stellenbosch Gesondheidsnavorsingsetiekkomitee, S19 / 02/031. Verder is toestemming verkry van die Ministerie van Gesondheid en Maatskaplike Dienste en die streeksgesondheidsdirekteur van die Kavango-Oos-streek. Bevindinge: Drie temas is geïdentifiseer: risikobewustheid, bemagtig vir selfversorging en volgehoue ondanks die uitdagings. Jong vroue in hierdie studie was bewus van hul risiko om MIV op te doen, en dit het hulle aangespoor om PrEP te gebruik. Hierdie risiko's sluit in 'n gebrek aan bewustheid van hul maat se MIV-status, tesame met 'n gebrek aan vertroue in hul vennote; of in 'n seksuele verhouding met 'n maat wat met MIV leef. Bewusmaking spruit ook uit inligting wat deur gesondheidswerkers, eweknieë en die media verskaf word. Die gebruik van PrEP het jong vroue bemagtig vir selfversorging deur hulle in staat te stel om keuses te maak om hul risiko te bestuur. Sommige van die vroue het aangehou om PrEP te gebruik, ondanks verskeie uitdagings wat die gebrek aan privaatheid, stigma en onvoldoende ondersteuning insluit. Gevolgtrekking en aanbevelings: PrEP is 'n bemagtigende strategie vir die voorkoming van MIV vir jong vroue, maar daar moet nog baie gedoen word om die bereidwilligheid van jong vroue om PrEP te inisieer en voort te sit, te bevorder. PrEP-bewusmakingsveldtogte moet uitgebrei word om mites en wanopvattings aan te spreek en sosiale norme positief te beïnvloed. Gedifferensieerde PrEP-afleweringsmodelle moet geïmplementeer word, insluitend integrasie met ander dienste soos seksuele reproduktiewe gesondheidsdienste, effektiewe berading en portuurondersteuning.
Description
Thesis (MNur)--Stellenbosch University, 2021.
Keywords
HIV infections -- Prevention -- Namibia, Pre-exposure prophylaxis -- Use studies -- Namibia, Young women -- Attitudes -- Namibia, UCTD
Citation