Perceived social influences on women’s decisions to use medications not studied in pregnancy: a qualitative ethical analysis of PrEP implementation research in Kenya

Implementation research ethics can be particularly challenging when pregnant women have been excluded from earlier clinical stages of research given greater uncertainty about safety and efficacy in pregnancy. The evaluation of HIV pre-exposure prophylaxis (PrEP) during pregnancy offered an opportunity to understand important ethical considerations and social influences shaping women’s decisions to participate in evaluation of PrEP and investigational drugs during pregnancy. We conducted interviews with women (n=51), focus groups with male partners (5 FGDs), interviews with health providers (n=45), 4 FGDs with pregnant/postpartum adolescents and 4 FGDs with young women. Data were analyzed using thematic content analysis, including ethical aspects of the data. Our study reveals that women navigate a complex network of social influences, expectations, support, and gender roles, not only with male partners, but with clinicians, family, and friends when making decisions about PrEP or other drugs that lack complete safety data during pregnancy

Predictors of Extra-Marital Partnerships among Women Married to Fishermen along Lake Victoria in Kisumu County, Kenya

BACKGROUND: The vulnerability of women to HIV infection makes establishing predictors of women's involvement in extra-marital partnerships critical. We investigated the predictors of extra-marital partnerships among women married to fishermen. METHODS: The current analyses are part of a mixed methods cross-sectional survey of 1090 gender-matched interviews with 545 couples and 12 focus group discussions (FGDs) with 59 couples. Using a proportional to size simple random sample of fishermen as our index participants, we asked them to enrol in the study with their spouses. The consenting couples were interviewed simultaneously in separate private rooms. In addition to socio-economic and demographic data, we collected information on sexual behaviour including extra-marital sexual partnerships. We analysed these data using descriptive statistics and multivariate logistic regression. For FGDs, couples willing to participate were invited, consented and separated for simultaneous FGDs by gender-matched moderators. The resultant audiofiles were transcribed verbatim and translated into English for coding and thematic content analysis using NVivo 9. RESULTS: The prevalence of extra-marital partnerships among women was 6.2% within a reference time of six months. Factors that were independently associated with increased likelihood of extra-marital partnerships were domestic violence (aOR, 1.45; 95% CI 1.09–1.92), women reporting being denied a preferred sex position (aOR, 3.34; 95% CI 1.26–8.84) and spouse longer erect penis (aOR, 1.34; 95% CI 1.00–1.78). Conversely, women's age – more than 24years (aOR, 0.33; 95% CI 0.14–0.78) and women's increased sexual satisfaction (aOR, 0.92; 95% CI 0.87–0.96) were associated with reduced likelihood of extra-marital partnerships. CONCLUSION: Domestic violence, denial of a preferred sex positions, longer erect penis, younger age and increased sexual satisfaction were the main predictors of women's involvement in extra-marital partnerships. Integration of sex education, counselling and life skills training in couple HIV prevention programs might help in risk reduction