Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;24(7):2149-2162.
doi: 10.1007/s10461-020-02780-x.

Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study

Carol S Camlin  1   2 , Catherine A Koss  3 , Monica Getahun  4 , Lawrence Owino  5 , Harriet Itiakorit  6 , Cecilia Akatukwasa  6 , Irene Maeri  5 , Robert Bakanoma  6 , Anjeline Onyango  5 , Frederick Atwine  6 , James Ayieko  5 , Jane Kabami  6 , Florence Mwangwa  6 , Mucunguzi Atukunda  6 , Asiphas Owaraganise  6 , Dalsone Kwarisiima  6 , Norton Sang  5 , Elizabeth A Bukusi  5 , Moses R Kamya  6   7 , Maya L Petersen  8 , Craig R Cohen  4 , Edwin D Charlebois  9 , Diane V Havlir  3
Affiliations

Understanding Demand for PrEP and Early Experiences of PrEP Use Among Young Adults in Rural Kenya and Uganda: A Qualitative Study

Carol S Camlin et al. AIDS Behav. 2020 Jul.

Abstract

Few studies have sought to understand factors influencing uptake and continuation of pre-exposure prophylaxis (PrEP) among young adults in sub-Saharan Africa in the context of population-based delivery of open-label PrEP. To address this gap, this qualitative study was implemented within the SEARCH study (NCT#01864603) in Kenya and Uganda, which achieved near-universal HIV testing, and offered PrEP in 16 intervention communities beginning in 2016-2017. Focus group discussions (8 groups, n = 88 participants) and in-depth interviews (n = 23) with young adults who initiated or declined PrEP were conducted in five communities, to explore PrEP-related beliefs and attitudes, HIV risk perceptions, motivations for uptake and continuation, and experiences. Grounded theoretical methods were used to analyze data. Young people felt personally vulnerable to HIV, but perceived the severity of HIV to be low, due to the success of antiretroviral therapy (ART): daily pill-taking was more threatening than the disease itself. Motivations for PrEP were highly gendered: young men viewed PrEP as a vehicle for safely pursuing multiple partners, while young women saw PrEP as a means to control risks in the context of engagement in transactional sex and limited agency to negotiate condom use and partner testing. Rumors, HIV/ART-related stigma, and desire for "proof" of efficacy militated against uptake, and many women required partners' permission to take PrEP. Uptake was motivated by high perceived HIV risk, and beliefs that PrEP use supported life goals. PrEP was often discontinued due to dissolution of partnerships/changing risk, unsupportive partners/peers, or early side effects/pill burden. Despite high perceived risks and interest, PrEP was received with moral ambivalence because of its associations with HIV/ART and stigmatized behaviors. Delivery models that promote youth access, frame messaging on wellness and goals, and foster partner and peer support, may facilitate uptake among young people.

Keywords: Adolescents; HIV prevention; Pre-exposure prophylaxis (PrEP); Sub-Saharan africa; Youth.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Birx D PEPFAR & HIV prevention: Locations and populations. HIV Research for Prevention (HIVR4P); October 17–21, 2016; Chicago, United States: 2016.
    1. Canning D, Raja S, Yazbeck AS. Africa’s demographic transition: Dividend or disaster? Washington, DC: World Bank; 2015.
    1. Strathdee SA. State of the global HIV pandemic: Where are we now? International AIDS Conference; July 18–22; Durban, South Africa: 2016.
    1. UNAIDS. Miles to go: Closing gaps, breaking barriers, righting injustices. Geneva, Switzerland; 2018.
    1. Thigpen MC, Kebaabetswe PM, Paxton LA, Smith DK, Rose CE, Segolodi TM, et al. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med. 2012;367(5):423–34. - PubMed

Substances