Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa

• Published in: Frontiers in reproductive health 2023-05, Vol.5, p.1073103-1073103
• Main Authors: Rousseau, Elzette, Wu, Linxuan, Heffron, Renee, Baeten, Jared M, Celum, Connie L, Travill, Danielle, Delany-Moretlwe, Sinead, Bekker, Linda-Gail, Bukusi, Elizabeth, Omollo, Victor, van der Straten, Ariane, O'Malley, Gabrielle, Haberer, Jessica E, Morton, Jennifer F, Johnson, Rachel E, Roberts, Sarah T
• Format: Article
• Language: English
• Subjects: adolescent girls and young women (AGYW); pre-exposure prophylaxis (PrEP); PrEP persistence; Reproductive Health; sexual and reproductive health outcomes; sexual relationship power
• ISSN: 2673-3153; 2673-3153
• DOI: 10.3389/frph.2023.1073103

Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence. The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence. In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04,  = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00,  = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33,