Safe PrEP Implementation Strategies for Women Reporting Intimate Partner Violence

Nurses and other providers should incorporate safety planning into PrEP care for women experiencing intimate partner violence.

One in 2 HIV positive women report experiencing intimate partner violence, in comparison with 1 in 4 women in the US general population. Strategies for HIV prevention are thus vital for women experiencing intimate partner violence.

Previously, few studies have examined safety-planning strategies related to provision of pre-exposure prophylaxis (PrEP) for women exposed to intimate partner violence. However, a recent study that was presented in an oral abstract session at the Association of Nurses in AIDS Care Conference (ANAC 2019) explored health care and social service providers’ perceptions on safety planning when initiating PrEP in this population.

The study was conducted by investigators from John Hopkins University School of Nursing, Brown University, and Yale University School of Public Health. The study team sought to understand what providers saw as strategies for preventing the escalation of violence, mitigating partner interference, and promoting PrEP adherence.

Investigators interviewed 9 women’s health care providers, 6 PrEP providers, and 9 intimate partner violence service providers in 60- to 90-minute semi-structured in-depth interviews. The interviews were audio-recorded and transcribed, then uploaded to the qualitative analysis application Dedoose. Recurring themes were identified by the study team using an inductive thematic analysis approach.

Investigators found providers agreed that safety planning was an integral part of conversations about PrEP with women experiencing intimate partner violence. Based on the themes analyzed, investigators identified 3 major components to effective safety planning. The first was to “assess danger” by getting to the root of what factors are leading to a woman potentially feeling unsafe taking PrEP. The second component that emerged in interviews was the need to maintain patient confidentiality concerning PrEP by “Keep(ing) it undisclosed”. Thirdly, providers highlighted a need to collaborate with patients to develop individuated plans for maximizing a specific woman’s safety while taking PrEP. Study authors referred to this as a need to engage in “a little bit of handholding.”

Investigators concluded that “safety planning is a key strategy to mitigating partner interference, avoiding further harm, and promoting adherence and retention to PrEP among women experiencing IPV.”

The authors of the abstract recommended that future research examine the role of nurses in facilitating safety planning around PrEP use. It was also recommended that health care and social service providers work together to craft trauma informed guidelines, recommendations, and training that includes safety planning as a part of the PrEP care continuum for women experiencing intimate partner violence.

The abstract, ‘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), was presented in an oral abstract session at ANAC 2019 in Portland, Oregon.