What drives adolescent girls and young women’s decisions to persist on PrEP? Results of a comparative qualitative study from a DREAMS program in western Kenya.
Outcomes: Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways Social support and perceived norms strongly shaped whether adolescent girls and young women persisted with pre-exposure prophylaxis. The discussion emphasizes that pervasive community stigma—particularly the misconception that pre-exposure prophylaxis users have HIV—can undermine persistence, while support from family and friends can counteract stigma and even compensate for unsupportive romantic partners. Programs may therefore benefit from engaging families and communities to normalize pre-exposure prophylaxis and strengthen supportive social environments.
Objectives The study explored factors influencing adolescent girls’ and young women’s decisions to persist with pre-exposure prophylaxis within the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe program in western Kenya.
Methods Researchers conducted a comparative qualitative study using semi-structured, in-depth interviews with 32 adolescent girls and young women in Kisumu and Homa Bay counties: 16 who persisted with pre-exposure prophylaxis and 16 who discontinued. Interviews underwent rapid inductive framework analysis, with themes compared between groups and interpreted using the Integrated Behavior Model. Social norms were examined through perceived norms, including participants’ perceptions of what people in their social networks thought they should do, anticipated reactions from others, stigma, disclosure, and support from partners, family, friends, and neighbors. Attitudes, knowledge, and personal agency were also examined.
Results All participants expressed positive attitudes toward pre-exposure prophylaxis, but misinformation was substantially more common among those who discontinued (14 of 16) than those who persisted (5 of 16), particularly regarding use during pregnancy and breastfeeding. Family and friend support distinguished the groups: 15 of 16 participants who persisted reported such support compared with 9 of 16 who discontinued. Community stigma was widespread, while unsupportive partners were reported in both groups. Strong mentors increased self-efficacy and helped participants overcome barriers, but knowledge and existing social support appeared more influential for persistence.
Conclusions Improving persistence requires more than positive individual attitudes. Programs should provide accurate information while extending education to families and communities to reduce stigma, correct misinformation, normalize pre-exposure prophylaxis use, and strengthen social support for adolescent girls and young women.
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.