"You Talk About Problems Until You Feel Free": South African Adolescent Girls' and Young Women's Narratives on the Value of HIV Prevention Peer Support Clubs

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2020 Jun 28

PMID 32590969

Citations 24

Authors

Deborah Baron

Fiona Scorgie

Lethabo Ramskin

Nomhle Khoza

Jennifer Schutzman

Anne Stangl

Sheila Harvey

Sinead Delany-Moretlwe

Affiliations

Soon will be listed here.

Abstract

Background: Daily oral pre-exposure prophylaxis (PrEP) can reduce HIV infection in adolescent girls and young women if used consistently during periods of risk. The EMPOWER study evaluated peer-based clubs incorporating an empowerment curriculum offered to adolescent girls and young women (16-24 years) in South Africa and Tanzania for adherence support.

Methods: Using serial in-depth interviews (n = 33), we assessed the benefits and challenges of club attendance among 13 EMPOWER participants in the Johannesburg site who were randomised to clubs. We used a summary matrix of coded data to support a narrative, case-based analysis. Four case studies are presented.

Results: Club participants reported benefits such as increased self-esteem and self-efficacy, reduced isolation, and greater insight into gender-based violence and strategies to address it. Day-to-day PrEP adherence was not the only topic discussed in clubs; participants also appreciated the safe space for sharing problems (such as relationship conflict and PrEP stigma) and found interactive exercises helpful in improving partner communication.

Conclusions: Findings support the use of peer-based clubs using a structured empowerment approach, which may offer valuable PrEP initiation support to adolescent girls and young women in settings with high HIV and gender-based violence prevalence.

Trial Registration: Pan African Clinical Trials Registry PACTR202006754762723 , 5 April 2020, retrospectively registered.

Citing Articles

Pre-exposure prophylaxis access, uptake and usage by young people: a systematic review of barriers and facilitators.

Warzywoda S, Fowler J, Dyda A, Fitzgerald L, Mullens A, Dean J Ther Adv Infect Dis. 2024; 11:20499361241303415.

PMID: 39650691 PMC: 11624559. DOI: 10.1177/20499361241303415.

Applying CFIR to assess multi-level barriers to PrEP delivery in rural South Africa: Processes, gaps and opportunities for service delivery of current and future PrEP modalities.

Baron D, Leslie H, Mabetha D, Becker N, Kahn K, Lippman S Soc Sci Med. 2024; 361:117370.

PMID: 39366151 PMC: 11554290. DOI: 10.1016/j.socscimed.2024.117370.

Women's Perceived HIV Stigma and Testing in Stann Creek District, Belize: A Population-Representing, Mixed-Methods Study.

Rossi S, Young K, Wade P, Khan S, Lunze K Am J Trop Med Hyg. 2024; 111(3):589-597.

PMID: 38981505 PMC: 11376188. DOI: 10.4269/ajtmh.23-0059.

Youth-friendly services was the magic: Experiences of adolescent girls and young women in the community PrEP study, South Africa.

Mudzingwa E, de Vos L, Fynn L, Atujuna M, Katz I, Hosek S Glob Public Health. 2024; 19(1):2349918.

PMID: 38752416 PMC: 11101151. DOI: 10.1080/17441692.2024.2349918.

Exploring adolescent girls and young women's PrEP-user profiles: qualitative insights into differentiated PrEP delivery platform selection and engagement in Cape Town, South Africa.

Rousseau E, Sikkema K, Julies R, Mazer K, OMalley G, Heffron R J Int AIDS Soc. 2024; 27(5):e26254.

PMID: 38695101 PMC: 11063778. DOI: 10.1002/jia2.26254.

References

Mugo N, Ngure K, Kiragu M, Irungu E, Kilonzo N . The preexposure prophylaxis revolution; from clinical trials to programmatic implementation. Curr Opin HIV AIDS. 2015; 11(1):80-6. PMC: 4900687. DOI: 10.1097/COH.0000000000000224. View

Scorgie F, Baron D, Stadler J, Venables E, Brahmbhatt H, Mmari K . From fear to resilience: adolescents' experiences of violence in inner-city Johannesburg, South Africa. BMC Public Health. 2017; 17(Suppl 3):441. PMC: 5498857. DOI: 10.1186/s12889-017-4349-x. View

Calabrese S, Dovidio J, Tekeste M, Taggart T, Galvao R, Safon C . HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood. J Acquir Immune Defic Syndr. 2018; 79(1):46-53. PMC: 6092222. DOI: 10.1097/QAI.0000000000001762. View

Jewkes R . HIV/AIDS. Gender inequities must be addressed in HIV prevention. Science. 2010; 329(5988):145-7. DOI: 10.1126/science.1193794. View

Jewkes R, Morrell R . Gender and sexuality: emerging perspectives from the heterosexual epidemic in South Africa and implications for HIV risk and prevention. J Int AIDS Soc. 2010; 13:6. PMC: 2828994. DOI: 10.1186/1758-2652-13-6. View

Rasschaert F, Decroo T, Remartinez D, Telfer B, Lessitala F, Biot M . Adapting a community-based ART delivery model to the patients' needs: a mixed methods research in Tete, Mozambique. BMC Public Health. 2014; 14:364. PMC: 3990026. DOI: 10.1186/1471-2458-14-364. View

Scorgie F, Khoza N, Baron D, Lees S, Harvey S, Ramskin L . Disclosure of PrEP use by young women in South Africa and Tanzania: qualitative findings from a demonstration project. Cult Health Sex. 2020; 23(2):257-272. DOI: 10.1080/13691058.2019.1703041. View

Cohen A, Raja S, Underhill C, Yaro B, Dokurugu A, de Silva M . Sitting with others: mental health self-help groups in northern Ghana. Int J Ment Health Syst. 2012; 6(1):1. PMC: 3366888. DOI: 10.1186/1752-4458-6-1. View

Sidebottom D, Ekstrom A, Stromdahl S . A systematic review of adherence to oral pre-exposure prophylaxis for HIV - how can we improve uptake and adherence?. BMC Infect Dis. 2018; 18(1):581. PMC: 6240194. DOI: 10.1186/s12879-018-3463-4. View

10.

Fonner V, Dalglish S, Kennedy C, Baggaley R, OReilly K, Koechlin F . Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016; 30(12):1973-83. PMC: 4949005. DOI: 10.1097/QAD.0000000000001145. View

11.

Ellsberg M, Arango D, Morton M, Gennari F, Kiplesund S, Contreras M . Prevention of violence against women and girls: what does the evidence say?. Lancet. 2014; 385(9977):1555-66. DOI: 10.1016/S0140-6736(14)61703-7. View

12.

Gray R, Fitch M, Davis C, Phillips C . A qualitative study of breast cancer self-help groups. Psychooncology. 1998; 6(4):279-89. DOI: 10.1002/(SICI)1099-1611(199712)6:4<279::AID-PON280>3.0.CO;2-0. View

13.

Heise L, Greene M, Opper N, Stavropoulou M, Harper C, Nascimento M . Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019; 393(10189):2440-2454. DOI: 10.1016/S0140-6736(19)30652-X. View

14.

Hosek S, Pettifor A . HIV Prevention Interventions for Adolescents. Curr HIV/AIDS Rep. 2019; 16(1):120-128. PMC: 6703904. DOI: 10.1007/s11904-019-00431-y. View

15.

Mark D, Armstrong A, Andrade C, Penazzato M, Hatane L, Taing L . HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub-Saharan African countries. J Int AIDS Soc. 2017; 20(Suppl 3):21591. PMC: 5719719. DOI: 10.7448/IAS.20.4.21591. View

16.

Zuma K, Shisana O, Rehle T, Simbayi L, Jooste S, Zungu N . New insights into HIV epidemic in South Africa: key findings from the National HIV Prevalence, Incidence and Behaviour Survey, 2012. Afr J AIDS Res. 2016; 15(1):67-75. DOI: 10.2989/16085906.2016.1153491. View

17.

Venables E, Edwards J, Baert S, Etienne W, Khabala K, Bygrave H . "They just come, pick and go." The Acceptability of Integrated Medication Adherence Clubs for HIV and Non Communicable Disease (NCD) Patients in Kibera, Kenya. PLoS One. 2016; 11(10):e0164634. PMC: 5072644. DOI: 10.1371/journal.pone.0164634. View

18.

Wingood G, Scd , DiClemente R . Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000; 27(5):539-65. DOI: 10.1177/109019810002700502. View

19.

Flamig K, Decroo T, van den Borne B, van de Pas R . ART adherence clubs in the Western Cape of South Africa: what does the sustainability framework tell us? A scoping literature review. J Int AIDS Soc. 2019; 22(3):e25235. PMC: 6531844. DOI: 10.1002/jia2.25235. View

20.

Subedar H, Barnett S, Chaka T, Dladla S, Hagerman E, Jenkins S . Tackling HIV by empowering adolescent girls and young women: a multisectoral, government led campaign in South Africa. BMJ. 2018; 363:k4585. PMC: 6284473. DOI: 10.1136/bmj.k4585. View