Overcoming structural violence through community-based safe-spaces: Qualitative insights from young women on oral HIV pre-exposure prophylaxis (PrEP) in Kisumu, Kenya.
Outcomes: Human Immunodeficiency Virus, Sexual and Reproductive Health, Women’s Economic Empowerment
View SourceKey Social Norms Take-aways Social norms—particularly those related to gender roles, stigma around HIV and PrEP, and expectations governing young women’s behavior—are deeply embedded within broader systems of structural violence and significantly shape access to HIV prevention services. The study highlights that norms around female respectability, sexuality, and obedience, as well as stigma linking PrEP to HIV and promiscuity, create powerful barriers to uptake. At the same time, community-based safe spaces can shift these norms by fostering peer support, enabling open dialogue, and building collective efficacy among young women. The discussion emphasizes that norms do not operate in isolation but are intertwined with institutional and economic constraints, and that safe spaces serve as a critical mechanism for transforming both individual perceptions and community-level expectations.
Objectives The study aimed to explore how community-based safe spaces contribute to overcoming structural violence—including sociocultural norms, institutional barriers, and economic constraints—that hinder access to HIV prevention services, particularly oral PrEP, among young women in Kisumu, Kenya.
Methods A qualitative, cross-sectional study design was used, involving semi-structured in-depth interviews (n=20) and focus group discussions (n=16) with 36 young women aged 18–24 enrolled in a community-based HIV prevention program (DREAMS). Guided by a structural violence framework, thematic analysis was conducted using Atlas.ti. Social norms were assessed through participants’ narratives capturing descriptive norms (common practices such as stigma and silence), injunctive norms (expectations around gender roles, sexuality, and disclosure), and broader sociocultural beliefs influencing health-seeking behaviors.
Results The study identified three key categories of structural barriers: institutional, sociocultural, and economic. Sociocultural norms—such as stigma around PrEP, taboos surrounding discussions of sex, and restrictive gender roles—limited young women’s autonomy and access to services. However, participation in safe spaces improved knowledge, reduced stigma, and increased confidence in discussing PrEP with partners and family members. Institutional barriers, including distance to clinics and negative provider attitudes, were mitigated through localized, supportive service delivery within safe spaces. Economic barriers, such as poverty and financial dependence, were addressed through livelihood training, reducing reliance on transactional relationships. Across these domains, safe spaces enhanced peer support, trust in providers, and uptake of HIV prevention services.
Conclusions The study concludes that community-based safe spaces are a promising intervention for addressing structural violence and shifting harmful social norms that hinder HIV prevention among young women. By integrating health services with social support and economic empowerment, these spaces can improve access, agency, and health outcomes. However, sustained impact requires supportive policies and broader structural changes to address the root causes of inequality.
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