Abstract
Women experience challenges engaging with the healthcare system, but frequently utilize hair salons; these are promising venues for family planning and HIV prevention services. Our objective was to assess the acceptability of nurse-offered contraceptive and PrEP services at hair salons in Durban, South Africa. We interviewed salon owners (N = 10) and clients (N = 42) and conducted focus groups with hair stylists (N = 43 stylists; 6 focus groups across five hair salons) to explore barriers and facilitators to providing contraception and PrEP in salons. After developing a codebook, we performed content analysis to identify themes within each conceptual area; 10% of transcripts were coded by two coders to ensure reliability. Content was analyzed according to the following categories: (1) facilitators of and (2) barriers to utilizing these services, and (3) factors to consider for program implementation. Participants identified convenience and female-oriented, supportive atmosphere as facilitators to offering HIV and contraceptive services in salons. Owners and stylists noted that establishing legitimacy was important for program success, including providing promotional pamphlets and employing nurses. Clients cited privacy concerns surrounding HIV testing in a public space as a significant barrier to using these services. Overall, participants were enthusiastic about the program. Convenience and a conducive environment were noted as facilitators to receiving health services in the hair salon; attention will have to be directed to establishing privacy and program legitimacy. Hair salons represent an innovative venue for reaching young women at high-risk for unintended pregnancy and HIV infection.
Highlights
South Africa has the largest population of individuals living with HIV in the world, with 7.2 million people infected as of 2017, 58% of whom are women [1]
Our objective was to use qualitative methods to assess the acceptability of nurse-provided contraceptive and pre-exposure prophylaxis (PrEP) services in hair salons in Durban, South Africa
This study explored barriers to and facilitators of offering contraceptive and PrEP services in hair salons in Durban, South Africa
Summary
South Africa has the largest population of individuals living with HIV in the world, with 7.2 million people infected as of 2017, 58% of whom are women [1]. Young women in South Africa are disproportionately affected both by the HIV epidemic and by a high burden of unintended pregnancies. The current annual HIV incidence rate for African women aged 20–34 is 4.5% in South Africa, meaning that four out of every 10 women who are 20 years-old today will have HIV by the time they are 34 [2]. Unintended pregnancies account for one-third of all births in sub-Saharan Africa, nearly half of which occur among women age 15–24. Young women are more likely to both discontinue contraception and use HIV pre-exposure prophylaxis (PrEP)
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