What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for hiv-serodiscordant couples

Norma C. Ware, Monique A. Wyatt, Jessica E. Haberer, Jared M. Baeten, Alexander Kintu, Christina Psaros, Steven Safren, Elioda Tumwesigye, Connie L. Celum, David R. Bangsberg

Research output: Contribution to journalArticlepeer-review

206 Scopus citations


Objective: Adherence may be the "Achilles heel" of pre-exposure prophylaxis (PrEP), a promising biomedical approach to HIV prevention. This article presents an explanation of PrEP adherence for African serodiscordant couples derived from qualitative data. Design: Explaining quantitative findings is one way qualitative investigation contributes to research in medicine and public health. This qualitative interview study was nested in the Partners PrEP Study, a phase III randomized trial evaluating oral tenofovir and emtricitabine/tenofovir PrEP to prevent HIV acquisition by HIVuninfected partners in serodiscordant heterosexual couples. Methods: In-depth qualitative interviews were provided by 60 Partners PrEP Study participants in Uganda. Interviews used openended questions eliciting information on adherence experiences, barriers, and facilitators. An inductive approach informed by grounded theory methodology was used to analyze study data. Results: The proposed explanation may be summarized as follows. Serodiscordance destabilizes couples, as the HIV-negative partner reacts with anger, fear, and sadness to the implication of infidelity represented by HIV infection. A "discordance dilemma" ensues, as the desire to avoid acquiring HIV and the advantages of preserving the relationship become competing priorities. PrEP is seen as a solution-a means of safeguarding health without ending the relationship. PrEP users benefit from the support of partners, who reinforce adherence. Where discord in the relationship persists, adherence suffers. Conclusions: PrEP adherence in serodiscordant couples may be understood as a function of the desire to reduce risk although preserving a partnered relationship. PrEP use in stable couples may be associated with improved adherence and thus, greater effectiveness.

Original languageEnglish (US)
Pages (from-to)463-468
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number5
StatePublished - Apr 15 2012
Externally publishedYes


  • Adherence
  • HIV acquisition
  • HIV prevention
  • HIV-serodiscordant couples
  • PrEP
  • Pre-exposure prophylaxis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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