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‘If the Partner Finds Out, then there’s Trouble’: Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV)

Abstract

Pre-exposure prophylaxis is an effective women-controlled HIV prevention strategy but women experiencing intimate partner violencefear partners’ interference and subsequent violence could limit its utility. This study explores provider perceptions of safety planning strategies to prevent escalating violence, mitigate partner interference, and promote daily oral PrEP adherence. We conducted interviews (N = 36) with healthcare providers (n = 18) and IPV service providers (n = 18) in Baltimore and New Haven. Using the Contextualized Assessment for Strategic Safety Planning model we organized data into two categories: the appraisal process and strategic safety planning. Themes revealed during the appraisal process, providers conduct routine IPV screening, facilitate HIV risk perception, and offer PrEP. Strategic safety planning utilizes concealment tactics, informal sources of support, role playing and cover stories. Future interventions to enhance PrEP services among women exposed to IPV should implement safety planning strategies, integrate PrEP care with IPV services, and employ novel PrEP modalities to maximize effectiveness.

Resumen

La profilaxis previa a la exposición (PrEP) es una estrategia eficaz de prevención del VIH controlada por las mujeres, pero las mujeres que experimentan violencia de pareja íntima (IPV) temen que la interferencia de la pareja y la posterior violencia puedan limitar su utilidad. Este estudio explora las percepciones de los proveedores sobre las estrategias de planificación de seguridad para prevenir la escalada de violencia, mitigar la interferencia de la pareja y promover la adherencia diaria a la PrEP oral. Realizamos entrevistas (N = 36) con proveedores de atención médica (n = 18) y proveedores de servicios de IPV (n = 18) en Baltimore y New Haven. Utilizando el modelo de Evaluación contextualizada para la planificación estratégica de la seguridad, organizamos los datos en dos categorías: el proceso de evaluación y la planificación estratégica de la seguridad. Temas revelados durante el proceso de evaluación, los proveedores realizan pruebas de detección de VPI de rutina, facilitan la percepción del riesgo de VIH y ofrecen PrEP. La planificación estratégica de seguridad utiliza tácticas de ocultación, fuentes informales de apoyo, juegos de roles e historias de cobertura. Las intervenciones futuras para mejorar los servicios de PrEP entre las mujeres expuestas a IPV deben implementar estrategias de planificación de seguridad, integrar la atención de PrEP con los servicios de IPV y emplear nuevas modalidades de PrEP para maximizar la efectividad.

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Data Availability

To prevent potential identification of participants, we will not share data or material from this study.

Code Availability

Not applicable.

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Funding

This study was funded by the Johns Hopkins Population Center [NIH/NICHD 5R24HD042854] and the Center for Interdisciplinary Research on AIDS – Yale University [P30MH062294]. TCW was supported by the National Institute on Minority Health and Health Disparities (NIMHD) [K01MD015005]. KAA was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Office for Research on Women’s Health (NICHD/ORWH) [K12HD085845].

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Authors

Contributions

Conceptualization: NKJ, KAA; Methodology: KAA; Formal analysis and investigation: NKJ, LC, KAA; Writing—original draft: NKJ, KAA, JZ; Writing—review and editing: KAA; TK, TCW; Funding acquisition: KAA; TK, TCW; Supervision: KAA.

Corresponding author

Correspondence to Kamila A. Alexander.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

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. The study was approved by the Johns Hopkins University School of Medicine Institutional Review Board (#IRB00129432) and Yale University Human Investigation Committee (#IRB1602017161).

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Informed consent to participate was obtained from all individual participants included in the study.

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Participants gave verbal informed consent to publish their data.

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Jeffers, N.K., Zemlak, J.L., Celius, L. et al. ‘If the Partner Finds Out, then there’s Trouble’: Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV). AIDS Behav 26, 2266–2278 (2022). https://doi.org/10.1007/s10461-021-03565-6

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Keywords

  • Intimate Partner Violence
  • HIV
  • Pre-exposure prophylaxis
  • Women