Motivations for Starting and Stopping PrEP: Experiences of Adolescent Girls and Young Women in the HPTN 082 Trial
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—particularly those related to gender, sexuality, and HIV stigma—are central to adolescent girls’ and young women’s (AGYW) decision-making around PrEP use, often outweighing individual risk perceptions. The discussion emphasizes that norms such as expectations of male infidelity, acceptance of condomless sex in relationships, stigma linking PrEP to HIV infection or “promiscuity,” and gendered power imbalances constrain women’s agency and shape start-stop behaviors. Critically, adherence decisions are less about rational alignment with HIV risk and more about navigating social expectations, disclosure risks, and relationship dynamics. Social support from peers, family, and providers can counter these norms, suggesting that shifting normative environments is essential for sustained HIV prevention.
Objectives The study aimed to explore motivations for starting, stopping, and restarting oral PrEP among AGYW participating in the HPTN 082 trial in South Africa and Zimbabwe, with a focus on understanding how decision-making aligns with HIV risk and is shaped by social and contextual factors.
Methods A qualitative study design was used, involving serial in-depth interviews with 60 AGYW aged 16–25 enrolled in the HPTN 082 open-label PrEP trial. Interviews were conducted at two time points and analyzed using thematic, inductive coding in NVivo. Heise’s dynamic framework—highlighted in the diagram on page 4—guided analysis, capturing multi-level influences (individual, social, institutional, material) with gender, power, and social norms embedded across all domains. Social norms were examined through narratives of stigma, gender expectations, partner dynamics, and community perceptions.
Results Perceived HIV vulnerability—often linked to partner infidelity and limited condom negotiation power—motivated PrEP initiation, but did not consistently drive prevention-effective use. PrEP discontinuation, pauses, and intermittent use were more strongly influenced by social and normative factors, including stigma (e.g., being perceived as HIV-positive or promiscuous), partner disapproval, and gendered expectations. Misconceptions about side effects, shaped by broader social beliefs, also contributed to discontinuation. Conversely, social support from peers, family, and clinic staff facilitated PrEP initiation and restart. Findings show that while some AGYW practiced prevention-effective use, most decisions were not aligned with changing HIV risk but rather with social pressures and lived realities.
Conclusions The study concludes that PrEP adherence among AGYW is deeply embedded in social and normative contexts rather than driven solely by individual risk assessment. Interventions must go beyond individual-level behavior change to address stigma, gender norms, and relationship dynamics, while strengthening social support systems. Community and mass media efforts to normalize HIV prevention, alongside improved counselling and education, are critical for enabling sustained and effective PrEP use among AGYW.
Disclaimer: These summaries were generated with the assistance of artificial intelligence and are based on the interpretation of source documents. While efforts have been made to ensure accuracy and clarity, there may be errors or omissions. Users are encouraged to consult the original documents for complete and authoritative information.