Key Social Norms Take-aways The key social norms insight is that HIV prevention efforts like PrEP cannot succeed through individual targeting alone; they must address the relational context, including norms around trust, fidelity, and male control over sexual health. Transforming these norms is crucial to enable young women to exercise agency in HIV prevention and to reduce their vulnerability within unequal relationship dynamics.

Objectives This study explores how gender norms and relationship dynamics shape HIV risk and prevention among young women in Durban, South Africa, with a focus on the acceptability and negotiation of oral pre-exposure prophylaxis (PrEP) in sexual partnerships.

Methods The study used qualitative methods, conducting 21 in-depth interviews with young women aged 18–25 enrolled in an HIV prevention trial and 8 interviews with male partners. Thematic analysis was applied to understand perceptions of relationship norms, gender roles, sexual expectations, and PrEP use.

Intervention Details Not applicable — this was a qualitative research study, not an intervention.

Results Findings revealed that young women face significant barriers to openly using PrEP due to expectations of monogamy, trust, and male control over sexual health decisions. Women reported concerns that PrEP use would be perceived as a sign of infidelity or mistrust, while men saw themselves as gatekeepers of sexual decision-making and were ambivalent or resistant to women’s independent PrEP use. Some couples found ways to negotiate PrEP use as a shared protective measure, but this required navigating entrenched power imbalances and communication challenges.

Conclusions The study concludes that while PrEP offers biomedical protection against HIV, its effective use depends heavily on relational and gender dynamics. Women’s ability to negotiate PrEP within their partnerships is constrained by social norms that link sexual health decisions to male authority and moral judgments about female sexuality.