Navigating PrEP Engagement Challenges: The Role of Social Relationships, Stigma, and Normalization Among AGYW in Namibia

Abstract

Adolescent girls and young women (AGYW) in Namibia remain disproportionately affected by HIV, yet consistent pre-exposure prophylaxis (PrEP) use remains low. This study explores how social relationships, stigma, and efforts to normalize PrEP use influence PrEP engagement among AGYW in Namibia. A secondary analysis of 58 qualitative interviews with AGYW aged 15–24 in the Khomas and Zambezi regions was conducted using thematic content analysis. Participants initiated PrEP primarily in response to structural vulnerabilities, including partner distrust and risk of sexual violence, viewing PrEP as a tool of self-protection and autonomy. However, adherence and continuation were shaped by complex interpersonal dynamics: many AGYW navigated partner disapproval, family stigma, misinformation, and privacy concerns, which created significant adherence challenges. Supportive relationships with family and peers, as well as individual coping strategies and self-efficacy, facilitated continued PrEP use despite these barriers. Findings highlight the critical need for interventions that address relational and structural barriers to PrEP use and strengthen AGYW’s agency and social support networks to sustain adherence.