Community perceptions about use of pre-exposure prophylaxis (PrEP) among adolescent girls and young women: A qualitative analysis

Abstract

Objectives: Adolescent girls and young women (AGYW) experience disproportionately higher rates of HIV acquisition compared to males of the same age, but PrEP uptake and continuation are low in this population. This study explored community perceptions around PrEP use among AGYW in Western Kenya. Design: Semi-structured in-depth focus group discussions (FGDs) were conducted with Community Advisory Board (CAB) members affiliated with two PrEP implementation projects targeting young women. Methods: FGDs were audio recorded, translated, and transcribed. Conventional content analysis and thematic networks analysis were used to identify themes relating to community perceptions of PrEP use among AGYW. Results: Four FGDs were conducted with 26 CAB members. Barriers to PrEP awareness among AGYW included lack of PrEP education in school HIV curriculum and failure of community leaders to sensitize and engage AGYW. Low uptake was thought to be associated with PrEP myths, and inaccurate understanding of who could benefit from PrEP and duration of use. AGYW may believe that PrEP is only for married/pregnant women or must be taken for life. PrEP use was viewed as unacceptable for AGYW in some communities because PrEP would increase “promiscuous” behavior, leading to decreased use of condoms and contraception, and increased STI incidence and pregnancy rates. Other barriers to uptake included confusion between PrEP and HIV treatment, lack of youth-friendly services at facilities, fear of HIV testing, and ease of access to condoms compared to PrEP. CAB members recommended integrating PrEP delivery into maternal and child health and family planning services, training community health volunteers to sensitize and deliver PrEP, and involving AGYW in policymaking as ways to improve access and uptake among AGYW. Conclusion: PrEP scale-up among AGYW will require community sensitization of AGYW to reduce stigma and clarify misperceptions.