Pre-exposure prophylaxis use among HIV serodiscordant couples: a qualitative study in Mozambique

Figures & data

Table 1. Qualitative interview guide

1.	How did you react to finding out you were HIV-negative and your partner was HIV-positive? (probe: did you consider leaving the relationship? What emotions/thoughts came up for you, or both of you together?)
2.	Did you tell any other people about the results you learned? If so, what were the reactions of people you told?
3.	Tell me what you were told about PrEP from the nurse/health care provider? What were the concerns you had about it? What benefits did you see in taking it? What influenced your decision to start taking it?
4.	Did you tell your partner that you were taking PrEP? What was his/her reaction? How did their reaction make you feel?
5.	How do you or did you feel about taking the medication? Do you or did you take the medication regularly as it was prescribed? If you are taking it intermittently, what information would help you be more adherent to your medication?
6.	Has anyone in your family known that you are or were taking PrEP medication? How have they reacted to this? If you have stopped taking the medication, do you think having a more supportive family member(s) would have helped you be more adherent to your medication (i.e. stay on PrEP medication longer)?
7.	People often learn more from stories than from listening to facts. We were thinking about offering people information about PrEP through storytelling. Imagine these three different situations:
	a.	A couple who struggles to overcome the difficulties associated with having a different HIV status compared to their partner. Specifically, the woman accuses the man of cheating on her and she is frustrated that she now has to take PrEP medication. Mostly she is scared that she will get HIV.
		What is the best way for the couple to stay together and be supportive of each other’s health?
	b.	A woman has an HIV-positive partner who refuses to take ART medication and doesn’t support her taking PrEP. She chooses to take her medication in secret and attend clinic visits in secret as well.
		Do you think a woman could manage this? What would be the best way to support her? (ex. other family? Friends? Health care workers? Educate her partner?)
	c.	A serodiscordant couple is very supportive of each other. They help each other remember to take their medications and help out with chores when one isn’t feeling well. The problem is that their extended family is not supportive of them staying together or the woman taking PrEP. They are rude to both the partners and spread rumors about them.
		How can a couple best manage this type of situation? What would be the best way to support them?

Italicized text indicates question probes or scenarios that precede questions

PrEP: Pre-Exposure Prophylaxis

Table 2. Oral story framework

	Situation	Facilitators of PrEP Use	Barriers to PrEP Use	Strategies to Overcome Barriers
1. A Positive Story	Partners are screened for HIV at a postnatal visit for their fourth child and the male partner tests positive while his female partner tests negative	The couple loves each other They want to be there for their children and new baby The couple listens to each other’s fears They encourage each other to adhere to their medications	Lack of knowledge about the purpose of PrEP Fear about how others in their community may react to learning that the male partner has HIV	They brought their questions to a health counsellor at the clinic They decide to keep their serodiscordant status to themselves to avoid stigma from their community
2. An Unsupportive Family	Partners are screened for HIV at the first prenatal care visit for their first child and the male partner tests positive while his female partner tests negative	The couple was tested together and received counselling together The couple want to keep themselves and their child healthy	The female partner is worried that her partner’s diagnosis means he was unfaithful They are scared to tell their family, as they are concerned that they will be judged for staying together Their family finds their medications and is upset and makes accusations	The clinic health counsellor explains the different ways that HIV can spread The couple engaged with a Peer Educator, who helped facilitate a conversation with the couple’s family, who then became supportive
3. A ‘Difficult’ Partner	Partners are screened for HIV at a prenatal care visit for their third child and the male partner tests positive while his female partner tests negative	The couple knew about PrEP from a neighbour and were initially interested	The male partner is angry about his diagnosis and the side effects from his ART and does not want to take them	The female partner requests assistance from the Peer Educator to help her male partner understand how taking his medications will protect his family and educate him about how long to expect the medication side effects to last The partners work together to remind each other to take their medications

PrEP: Pre-Exposure Prophylaxis

ART: Antiretroviral Therapy

Figure 1. Socioecological factors influencing pre-exposure prophylaxis use among couples in HIV discordant relationships in rural Mozambique