Abstract
Background: HIV incidence remains high among pregnant and postpartum women in Kenya despite access to HIV pre-exposure prophylaxis (PrEP).1–4 Male partners influence women’s individual PrEP decisions,5–7 yet few studies evaluate community-level gender and power dynamics. Aligned with calls for feminist global health research,8,9 we explored gender-based determinants and structural challenges of pregnant women’s PrEP use through a feminist lens.
Methods: We conducted focus group discussions (FGDs) in English, Dholuo, and Swahili with healthcare workers (HCW) and community advisory board (CAB) members of a randomized trial (NCT04472884) that enrolled pregnant women initiating PrEP at antenatal clinics in western Kenya.10 FGD topics included PrEP knowledge and adherence, HIV prevention, and long-acting (LA) PrEP. Kenyan team members translated and transcribed the FGDs verbatim in English. Guided by critical thematic analysis and a feminist lens, we open-coded transcripts in Dedoose, created gender-focused codes inductively, and generated themes.11,12
Findings: We conducted 9 FGDs from October to December 2023, 5 with HCWs and 4 with CAB members. Of the 46 participants, a majority (67%) were female and the median age was 36 years (IQR: 31-47). Participants observed that women modify their PrEP use in response to men’s power in relationships, particularly in connection with men’s social status, financial security, and perceived or known infidelity. Some participants shared that women secretly use PrEP, fearing that disclosure may lead to intimate partner violence (IPV) or job loss. Participants noted that men’s barriers to PrEP use include ego, less contact with health systems as compared to women, and myth that only women and female sex workers are at risk for HIV. Women’s autonomy and agency were perceived to be undermined by community beliefs, including stigma from associating PrEP use with promiscuity, and misinformation that PrEP is an HIV treatment. Participants felt that LA-PrEP could enhance privacy, improve adherence, and reduce stigma and IPV. However, participants caution LA-PrEP may reinforce gender roles like those in family planning, where women are expected to bear the responsibility for sexual health.
Conclusion: Community-level gender barriers, power imbalances, and cultural norms significantly affect women's PrEP access, use, and adherence. A critical feminist lens helps identify key determinants to support global health equity efforts.
Sigma Membership
Psi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Sustainable Development Goals, Health Equity or Social Determinants of Health, Implementation Science, HIV, HIV Pre-Exposure Prophylaxis, PrEP, Kenya
Recommended Citation
Strong, Marin; Concepcion, Tessa; Abuna, Felix; Akim, Eunita; Aketch, Helen; Gomez, Lauren; Suh, Bih Moki; Mukenyi, Emma; Ngumbau, Nancy; Mogaka, Jerusha Nyabiage; Obatsa, Sarah; Odhiambo, Ben Ochieng; Omom, Caroline; Watoyi, Salphine; Ngure, Kenneth; Beima-Sofie, Kristin M.; John-Stewart, Grace C.; Kinuthia, John; and Pintye, Jillian, "A Feminist Analysis of Kenyan Women’s Use of HIV Pre-Exposure Prophylaxis During Pregnancy" (2025). International Nursing Research Congress (INRC). 90.
https://www.sigmarepository.org/inrc/2025/presentations_2025/90
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
A Feminist Analysis of Kenyan Women’s Use of HIV Pre-Exposure Prophylaxis During Pregnancy
Seattle, Washington, USA
Background: HIV incidence remains high among pregnant and postpartum women in Kenya despite access to HIV pre-exposure prophylaxis (PrEP).1–4 Male partners influence women’s individual PrEP decisions,5–7 yet few studies evaluate community-level gender and power dynamics. Aligned with calls for feminist global health research,8,9 we explored gender-based determinants and structural challenges of pregnant women’s PrEP use through a feminist lens.
Methods: We conducted focus group discussions (FGDs) in English, Dholuo, and Swahili with healthcare workers (HCW) and community advisory board (CAB) members of a randomized trial (NCT04472884) that enrolled pregnant women initiating PrEP at antenatal clinics in western Kenya.10 FGD topics included PrEP knowledge and adherence, HIV prevention, and long-acting (LA) PrEP. Kenyan team members translated and transcribed the FGDs verbatim in English. Guided by critical thematic analysis and a feminist lens, we open-coded transcripts in Dedoose, created gender-focused codes inductively, and generated themes.11,12
Findings: We conducted 9 FGDs from October to December 2023, 5 with HCWs and 4 with CAB members. Of the 46 participants, a majority (67%) were female and the median age was 36 years (IQR: 31-47). Participants observed that women modify their PrEP use in response to men’s power in relationships, particularly in connection with men’s social status, financial security, and perceived or known infidelity. Some participants shared that women secretly use PrEP, fearing that disclosure may lead to intimate partner violence (IPV) or job loss. Participants noted that men’s barriers to PrEP use include ego, less contact with health systems as compared to women, and myth that only women and female sex workers are at risk for HIV. Women’s autonomy and agency were perceived to be undermined by community beliefs, including stigma from associating PrEP use with promiscuity, and misinformation that PrEP is an HIV treatment. Participants felt that LA-PrEP could enhance privacy, improve adherence, and reduce stigma and IPV. However, participants caution LA-PrEP may reinforce gender roles like those in family planning, where women are expected to bear the responsibility for sexual health.
Conclusion: Community-level gender barriers, power imbalances, and cultural norms significantly affect women's PrEP access, use, and adherence. A critical feminist lens helps identify key determinants to support global health equity efforts.
Description
Kenyan women face high HIV incidence in pregnancy and their pre-exposure prophylaxis (PrEP) use may be impacted by gender-specific barriers. Data from focus group discussions with healthcare workers and community advisory board members was analyzed using a feminist lens to understand the influences of gender and power. Themes revealed male egos, stigma, and relational power as key barriers for women. Future PrEP products may increase privacy but could reinforce traditional gender roles.