“When he is around, I’ll take the PrEP, but when he is not, I will not take PrEP”: key influences on PrEP use decisions among women attending family planning clinics in Kenya
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Social norms—particularly those related to gender power dynamics, partner influence, and HIV-related stigma—play a central role in shaping women’s decisions around PrEP use in Kenya. Norms that prioritize male partner authority, require partner approval, and associate PrEP with HIV treatment create barriers to uptake, delay, and discontinuation. The study highlights that women’s agency is often constrained by expectations around relationship dynamics and fear of stigma or misinterpretation by partners and communities. Importantly, PrEP use is not a one-time decision but a dynamic process influenced by shifting social contexts, suggesting that interventions must address relational and community-level norms alongside individual factors to support sustained use.
Objectives The study aims to explore key influences on PrEP use decision-making among women of childbearing age attending family planning clinics in Kenya, focusing on why women decline, delay, discontinue, or restart PrEP.
Methods This qualitative study was nested within a larger implementation trial (FP-Plus) and conducted through in-depth interviews with 64 women (ages ≥15) attending family planning clinics. Participants were purposively sampled across four PrEP decision categories (decline, delay, discontinue, restart). Data were analyzed using inductive and deductive thematic analysis, guided by the Theory of Planned Behavior (TPB). Social norms were explored through themes related to subjective norms, including partner influence, social expectations, stigma, and community beliefs about PrEP.
Results PrEP use decisions were shaped by a complex interplay of perceived HIV risk, agency, social influences, and product-related factors. Social norms emerged as key barriers: partner opposition, lack of privacy, and fear of stigma discouraged initiation and adherence. Many women feared that PrEP would be mistaken for HIV treatment, leading to assumptions about infidelity or HIV status. Social expectations around joint decision-making further limited women’s autonomy, particularly among younger women. At the same time, improved knowledge through healthcare providers helped counter misinformation and supported uptake. PrEP use was often cyclical, with women initiating or restarting use during periods of perceived higher HIV risk (e.g., partner presence or increased risk behaviors).
Conclusions The study concludes that PrEP use among women is shaped by dynamic social, relational, and structural factors. Low autonomy, stigma, and partner influence remain key barriers to sustained use. Effective interventions should focus on enhancing women’s decision-making power, improving community awareness, and addressing stigma and misinformation. Integrating PrEP into family planning services and offering alternative formulations may further support uptake, but meaningful progress requires addressing the underlying social norms that constrain women’s choices.
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