“I Stopped to Prove them Wrong:” Reasons for Discontinuing Daily Oral HIV Pre-exposure Prophylaxis Among Women at High Risk of HIV in Tanzania-A Convergent Mixed Methods Study.
Outcomes: Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways Social norms and social pressure were important drivers of discontinuing daily oral pre-exposure prophylaxis among female sex workers. Women described a common community belief that people taking pills resembling antiretroviral treatment are living with HIV, leading to stigma, rumors, negative reactions, and pressure from partners, family, friends, peers, and clients to stop taking pre-exposure prophylaxis. The discussion emphasizes that improving retention requires community sensitization and education that correct misunderstandings about pre-exposure prophylaxis and actively engage women’s social networks to support continued use.
Objectives To examine reasons for discontinuing daily oral pre-exposure prophylaxis among female sex workers in Tanga, Tanzania, and inform strategies to strengthen implementation and retention.
Methods This convergent mixed-methods study recruited 313 female sex workers through respondent-driven sampling and followed them for 12 months between February 2022 and June 2023, collecting quantitative data at baseline and months 1, 6, and 12. At month 12, 11 women who had discontinued pre-exposure prophylaxis participated in in-depth interviews. Quantitative analyses included descriptive statistics and log-binomial regression, while qualitative data underwent thematic analysis; findings were triangulated and interpreted using the Health Belief Model. Social factors included a 10-item pre-exposure prophylaxis stigma scale and an eight-item social support measure, while qualitative interviews explored perceived social norms, stigma, and pressure from partners, family, friends, peers, and clients.
Results Discontinuation for three months or longer was reported by 61.5% of participants at month 6 and 67.4% at month 12. Reasons included medical and pharmacological challenges, social norms and societal pressure, unfavorable pill characteristics and daily dosing, low perceived HIV risk, low perceived benefit, and low self-efficacy. Socially, 21.6% reported negative reactions to pre-exposure prophylaxis use, and 6.3% reported that partners or family did not want them using it. Qualitative findings showed that women feared being mistaken for living with HIV because pre-exposure prophylaxis resembled antiretroviral treatment; this produced stigma and pressure to discontinue.
Conclusions Pre-exposure prophylaxis discontinuation reflects multiple interacting medical, individual, treatment-related, and social factors. Reducing discontinuation therefore requires multifaceted strategies that address stigma and harmful social perceptions alongside risk perceptions, treatment concerns, perceived benefits, and self-efficacy.
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