How gender norms and ‘good girl’ notions prevent adolescent girls and young women from engaging with PrEP: qualitative insights from Zimbabwe.
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways Rigid gender norms around sexual morality, obedience, and reputation prevent AGYW from using PrEP. These norms are enforced by families, male partners, and even health providers, limiting girls’ autonomy. Effective PrEP programs must go beyond clinical availability to address stigma, reshape community attitudes, and create enabling environments where AGYW can make informed, stigma-free decisions about HIV prevention.
Objectives This study examined how gender norms and social expectations about femininity influence adolescent girls and young women’s (AGYW) engagement with pre-exposure prophylaxis (PrEP) for HIV prevention in eastern Zimbabwe. It focused on how “good girl” ideals and community-level stigma create barriers to PrEP uptake.
Methods The study used qualitative methods embedded in a broader mixed-methods HIV prevention trial. Researchers conducted 12 in-depth interviews and 3 focus group discussions with 26 AGYW aged 18–24 from rural and urban sites in Manicaland, Zimbabwe. Participants were selected from a baseline survey of the parent study. Thematic analysis was informed by Connell’s theory of emphasized femininity, exploring how gender power dynamics shape decisions and access to PrEP.
Results A prominent representation of emphasized femininity and imbalanced power relations between men and women dominated participants’ accounts of their social reality vis-a-vis opportunities to engage with PrEP. AGYW described how cultural norms portray sexual activity outside marriage as inappropriate and shameful. PrEP use, linked with sexual autonomy, conflicted with these expectations. Many feared being seen as promiscuous or unfaithful if they used PrEP, deterring them from seeking it. Girls reported concerns about confidentiality in clinics, lack of privacy at home, and fear of gossip from family, peers, and healthcare workers. Male partner approval and parental control further restricted access. Even motivated users found it difficult to use PrEP discreetly. Some girls were willing to resist gender expectations but recognized the social risks.
Conclusions In patriarchal settings, PrEP use is not fully under the control of AGYW. Social expectations around femininity and sexual behavior shape how girls access, perceive, and use HIV prevention methods. Without addressing these underlying dynamics, PrEP programs risk excluding those most in need. To break the connection between PrEP stigma and ‘good girl’ notions, gender-transformative community mobilisation activities must be implemented alongside PrEP programming that is more inclusive of the wider population, rather than women in sex work first then others, to reduce “establishing” stigma.
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