Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa

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dc.contributor.authorViljoen, Lario
dc.contributor.authorHoddinott, Graeme
dc.contributor.authorMalunga, Samantha
dc.contributor.authorVanqa, Nosivuyile
dc.contributor.authorMhlakwaphalwa, Tembeka
dc.contributor.authorMarthinus, Arlene
dc.contributor.authorMcimeli, Khanyisa
dc.contributor.authorBond, Virginia
dc.contributor.authorSeeley, Janet
dc.contributor.authorBock, Peter
dc.contributor.authorHayes, Richard
dc.contributor.authorReynolds, Lindsey
dc.date.accessioned2021-11-02T11:45:05Z
dc.date.available2021-11-02T11:45:05Z
dc.date.issued2021-10-24
dc.date.updated2021-10-31T04:18:21Z
dc.description.abstractBackground HIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women’s sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment. Methods We employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18–35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV. Results We found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women’s thinking about sex. In their scripts, women idealised romantic sex, positioned sex as ‘about relationships’, and described risky sex as ‘other’. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts. Conclusion These findings suggest that HIV-negative women did not include their partners’ use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively—through community-wide viral suppression—rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being.en_US
dc.identifier.apacitationViljoen, L., Hoddinott, G., Malunga, S., Vanqa, N., Mhlakwaphalwa, T., Marthinus, A., ... Reynolds, L. (2021). Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa. <i>BMC Women's Health</i>, 21(rticle number: 370), http://hdl.handle.net/11427/35298en_ZA
dc.identifier.chicagocitationViljoen, Lario, Graeme Hoddinott, Samantha Malunga, Nosivuyile Vanqa, Tembeka Mhlakwaphalwa, Arlene Marthinus, Khanyisa Mcimeli, et al "Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa." <i>BMC Women's Health</i> 21, rticle number: 370. (2021) http://hdl.handle.net/11427/35298en_ZA
dc.identifier.citationViljoen, L., Hoddinott, G., Malunga, S., Vanqa, N., Mhlakwaphalwa, T., Marthinus, A., Mcimeli, K. & Bond, V. et al. 2021. Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa. <i>BMC Women's Health.</i> 21(rticle number: 370) http://hdl.handle.net/11427/35298en_ZA
dc.identifier.ris TY - Journal Article AU - Viljoen, Lario AU - Hoddinott, Graeme AU - Malunga, Samantha AU - Vanqa, Nosivuyile AU - Mhlakwaphalwa, Tembeka AU - Marthinus, Arlene AU - Mcimeli, Khanyisa AU - Bond, Virginia AU - Seeley, Janet AU - Bock, Peter AU - Hayes, Richard AU - Reynolds, Lindsey AB - Background HIV treatment-based prevention modalities present new opportunities for women to make decisions around sex, intimacy, and prevention. The Universal test and treat (UTT) strategy, where widespread HIV testing is implemented and all people with HIV can access treatment, has the potential to change how sex is understood and HIV prevention incorporated into sexual relationships. We use the frame of sexual scripting to explore how women attribute meaning to sex relative to UTT in an HIV prevention trial setting. Exploring women’s sexual narratives, we explored how HIV prevention feature in the sexual scripts for women who had access to UTT in South Africa (prior to treatment guideline changes) and increased HIV prevention messaging, compared to places without widespread access to HIV testing and immediate access to treatment. Methods We employed a two-phased thematic analysis to explore longitudinal qualitative data collected from 71 women (18–35 years old) between 2016 and 2018 as part of an HIV prevention trial in the Western Cape Province, South Africa. Of the participants, 58/71 (82%) were from intervention communities while 13/71 (18%) lived in control communities without access to UTT. Twenty participants self-disclosed that they were living with HIV. Results We found no narrative differences between women who had access to UTT and those who did not. HIV and HIV prevention, including treatment-based prevention modalities, were largely absent from women’s thinking about sex. In their scripts, women idealised romantic sex, positioned sex as ‘about relationships’, and described risky sex as ‘other’. When women were confronted by HIV risk (for example, when a partner disclosed his HIV-positive status) this created a point of disjuncture between this new perception of risk and their accepted relationship scripts. Conclusion These findings suggest that HIV-negative women did not include their partners’ use of antiretroviral therapy in their sexual partnership choices. For these women, the preventive benefits of UTT are experienced passively—through community-wide viral suppression—rather than through their own behaviour change explicitly related to the availability of treatment as prevention. We propose that prevention-based modalities should be made available and supported and framed as an intervention to promote relationship well-being. DA - 2021-10-24 DB - OpenUCT DP - University of Cape Town IS - rticle number: 370 J1 - BMC Women's Health KW - South Africa KW - Sexual scripting KW - HIV KW - Universal test and treat KW - Treatment as prevention LK - https://open.uct.ac.za PY - 2021 T1 - Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa TI - Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa UR - http://hdl.handle.net/11427/35298 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12905-021-01513-z
dc.identifier.urihttp://hdl.handle.net/11427/35298
dc.identifier.vancouvercitationViljoen L, Hoddinott G, Malunga S, Vanqa N, Mhlakwaphalwa T, Marthinus A, et al. Women’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africa. BMC Women's Health. 2021;21(rticle number: 370) http://hdl.handle.net/11427/35298.en_ZA
dc.language.rfc3066en
dc.publisher.departmentAids and Society Research Uniten_US
dc.publisher.facultyFaculty of Humanitiesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Women's Healthen_US
dc.source.journalissuerticle number: 370en_US
dc.source.journalvolume21en_US
dc.source.urihttps://bmcwomenshealth.biomedcentral.com/
dc.subjectSouth Africaen_US
dc.subjectSexual scriptingen_US
dc.subjectHIVen_US
dc.subjectUniversal test and treaten_US
dc.subjectTreatment as preventionen_US
dc.titleWomen’s sexual scripting in the context of universal access to antiretroviral treatment—findings from the HPTN 071 (PopART) trial in South Africaen_US
dc.typeJournal Articleen_US
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