Abstract
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. Few studies have explored adolescents and young people’s perspectives toward PrEP. We conducted 24 group discussions and 60 in-depth interviews with males and females aged 13–24 years in Uganda, Zimbabwe, and South Africa between September 2018 and February 2019. We used the framework approach to generate themes and key concepts for analysis following the social ecological model. Young people expressed a willingness to use PrEP and identified potential barriers and facilitators of PrEP uptake. Barriers included factors at individual (fear of HIV, fear of side effects, and PrEP characteristics), interpersonal (parental influence, absence of a sexual partner), community (peer influence, social stigma), institutional (long waiting times at clinics, attitudes of health workers), and structural (cost of PrEP and mode of administration, accessibility concerns) levels. Facilitators included factors at individual (high HIV risk perception and preventing HIV/desire to remain HIV negative), interpersonal (peer influence, social support and care for PrEP uptake), community (adequate PrEP information and sensitization, evidence of PrEP efficacy and safety), institutional (convenient and responsive services, provision of appropriate and sufficiently resourced services), and structural (access and availability of PrEP, cost of PrEP) levels. The findings indicated that PrEP is an acceptable HIV prevention method. PrEP uptake is linked to personal and environmental factors that need to be considered for successful PrEP roll-out. Multi-level interventions needed to promote PrEP uptake should consider the social and structural drivers and focus on ways that can inspire PrEP uptake and limit the barriers.
Highlights
Pre-exposure prophylaxis (PrEP) is a promising and effective HIV prevention strategy, utilizing antiretroviral (ARV) medication taken as a single oral pill to prevent the acquisition of HIV (Golub, Gamarel, & Surace, 2017)
Previous work among men who have sex with men (MSM) showed that stigma, drug effects, and adherence were among the barriers to PrEP uptake (Holloway et al, 2017; Owens et al, 2020), while a facilitator of uptake was the provision of PrEP free of charge (Golub et al, 2017)
Drawing upon the social ecological model (SEM) framework, we offer theoretically informed insights regarding the potential barriers and facilitators associated with providing this form of prevention to PrEP-naive AYP populations
Summary
Pre-exposure prophylaxis (PrEP) is a promising and effective HIV prevention strategy, utilizing antiretroviral (ARV) medication taken as a single oral pill to prevent the acquisition of HIV (Golub, Gamarel, & Surace, 2017). As part of the strategies to attain the 95-95-95 fast-track action to end the AIDS epidemic by 2030, engaging AYP in the co-creation of HIV prevention strategies, including PrEP, needs to be rapidly adopted in sub-Saharan settings such as Uganda, Zimbabwe, and South Africa with growing AYP populations to successfully reduce the epidemic (United Nations, 2012; United Nations General Assembly, 2016; World Health Organization, 2017a). This is critical as many of these countries have large adolescent populations at high risk of HIV infection with high HIV incidence rates (Baeten et al, 2012; Shisana et al, 2014; World Health Organization, 2012). Drawing upon the SEM framework, we offer theoretically informed insights regarding the potential barriers and facilitators associated with providing this form of prevention to PrEP-naive AYP populations
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