“I will take PrEP because that’s what will help me not to get infected with HIV”: barriers to and facilitators of pre-exposure prophylaxis and condom use among adolescent girls and young women enrolled in a school-based HIV prevention program in South Africa
Outcomes: Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways Social norms and gendered relationship dynamics strongly influence HIV prevention behaviors among adolescent girls and young women (AGYW). Condom use is often constrained by norms linking condom negotiation with distrust, reduced male pleasure, and potential conflict or violence. In contrast, PrEP offers women greater agency because it can be used without partner negotiation. The study also shows that norms around PrEP are still emerging and can be positively shaped through youth-friendly school-based programs that normalize its use.
Objectives The study explored barriers to and facilitators of PrEP and condom use among AGYW enrolled in a school-based HIV prevention program in South Africa, using the HIV prevention cascade framework to understand factors affecting knowledge, motivation, access, and effective use of HIV prevention methods.
Methods Researchers conducted qualitative semi-structured interviews with 16 AGYW aged 16–20 who had never used PrEP, were currently using it, or had stopped. Interviews were recorded, transcribed, and analyzed using the framework method, with deductive coding based on the HIV prevention cascade (knowledge, motivation, access, and effective use).
Intervention Details The study was embedded within the Imagine programme, a school-based HIV prevention initiative that provides AGYW with sexual and reproductive health services including PrEP, condoms, counseling, and psychosocial support through youth-friendly “Safe Spaces” located on school grounds.
Results Participants had high awareness of HIV and pregnancy risks and strong knowledge about PrEP due to program exposure, though knowledge about condoms and correct use was limited. Fear of HIV motivated prevention behaviors, but condom use was often undermined by partner resistance, unequal gender power dynamics, and fears of relationship conflict or violence. PrEP was viewed positively because it allowed women to protect themselves even when partners refused condoms. School-based services were widely accepted due to their privacy, accessibility, and non-judgmental staff, while community clinics were associated with stigma, long waits, and judgmental providers.
Conclusions Persistent social norms and power imbalances continue to limit condom use among AGYW, but attitudes toward PrEP appear more flexible and responsive to supportive programming. Youth-friendly school-based HIV prevention services can improve access and help normalize PrEP use, though programs should also strengthen education on condom use and promote dual protection.
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