Motivated Reasoning and HIV Risk? Views on Relationships, Trust, and Risk from Young Women in Cape Town, South Africa, and Implications for Oral PrEP
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In high prevalence environments relationship characteristics are likely to be associated with HIV risk, yet evidence indicates general underestimation of risk. Furthermore uncertainty about partner‘s risk may challenge PrEP demand among young African women. We conducted quantitative and qualitative interviews with women before and after HIV discussions with partners, to explore how partner’s behavior affected risk perceptions and interest in PrEP. Twenty-three women were interviewed once; twelve had a follow-up interview after speaking to their partners. Fourteen women were willing to have their partner contacted; yet two men participated. Several themes related to relationships and risk were identified. These highlighted that young women’s romantic feelings and expectations influenced their perceptions of risk within their relationships, consistent with the concept of motivated reasoning. Findings emphasize challenges in using risk to promote HIV prevention among young women. Framing PrEP in a positive empowering way that avoids linking it to relationship risk may ultimately encourage greater uptake.
KeywordsHIV risk HIV prevention Female-initiated methods Pre-exposure prophylaxis
We would like to pay tribute to the women and men who participated in this study, their participation made this study possible. The contributions of Jonah Leslie are acknowledged as critical in the analysis of this study. This study was supported by the National Institutes of Health (1R01MH107251). Writing of this manuscript was supported in part by internal funds from RTI International. The content is solely the responsibility of the authors and does not necessarily represent the official views of the authors’ employers or funders.
This study was funded by the National Institutes of Health (grant number 1R01MH107251).
Compliance with Ethical Standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Medicines Control Council approves fixed -dose combination of tenofovir disoproxyl fumarate and emtricitabine for pre-exposure prophylaxis of HIV [press release]. Pretoria: Registrar of Medicines, Medicines Control Council 2015.Google Scholar
- 2.Recommendations on the Use of PrEP for All Populations, PEPFAR Scientific Advisory Board (SAB). PrEP Expert Working Group (EWG); 2015.Google Scholar
- 3.WHO. WHO Expands Recommendation on Oral Pre-Exposure Prophylaxis of HIV Infection (PrEP). Geneva: WHO; 2015.Google Scholar
- 7.UNAIDS. Global Report: UNAIDS report on the global AIDS epidemic, Geneva. Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2013. p. 2013.Google Scholar
- 8.UNAIDS. The Gap Report. Geneva, Switzerland; 2014.Google Scholar
- 9.Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Zungu N, et al. South African National HIV Prevalence, Incidence and Behavior Survey, 2012. Cape Town: Human Sciences Research Council (HSRC); 2014.Google Scholar
- 20.Dolley C. No end in sight for Masi protests. IOL News. 2015 25 October 2015;Sect. Crime & Courts.Google Scholar
- 23.Gourlay A, Mshana G, Birdthistle I, Bulugu G, Zaba B, Urassa M. Using vignettes in qualitative research to explore barriers and facilitating factors to the uptake of prevention of mother-to-child transmission services in rural Tanzania: a critical analysis. BMC Med Res Methodol. 2014;14(1):21.CrossRefGoogle Scholar
- 25.Slovic P, Finucane M, Peters E, MacGregor DG. Heuristics and biases. In: Gilovich T, Griffin D, Kahneman D, editors. The psychology of intuitive judgment. New York: Cambridge University Press; 2002.Google Scholar
- 28.Morrell R. The times of change: men and masculinity in South Africa. In: Morrell R, editor. In changing men in Southern Africa. Pietermaritzburg: University of Natal Press; 2001. p. 3–56.Google Scholar
- 29.O’Sullivan LF, Harrison A, Morrell R, Monroe-Wise A, Kubeka M. Gender dynamics in the primary sexual relationships of young rural South African women and men. Culture. 2006;8(2):99–113.Google Scholar
- 32.Pettifor A, MacPhail C, Anderson A, Maman S. ‘If I buy the Kellogg’s then he should [buy] the milk’: young women’s perspectives on relationship dynamics, gender power and HIV risk in Johannesburg, South Africa. Culture. 2012;14(5):477–90.Google Scholar
- 41.Barker G, Ricardo C, Nascimento M. Engaging men and boys in changing gender-based inequity in health: evidence from programme interventions. Geneva: World Health Organization; 2007.Google Scholar
- 42.Ricardo C, Eads M, Barker G. Engaging boys and young men in the prevention of sexual violence: a systematic and global review of evaluated interventions. Cape Town/Rio de Janeiro: Sexual Violence Research Initiative/Instituto Promundo; 2011.Google Scholar