Key influences on the decision to initiate PrEP among adolescent girls and young women within routine maternal child health and family planning clinics in Western Kenya

ABSTRACT

We sought to understand influences on PrEP uptake among Kenyan adolescent girls and young women (AGYW) whose decision on PrEP use was misaligned with their risk for HIV acquisition. In-depth interviews were conducted with 47 Kenyan HIV-negative AGYW aged 15–24 years who were offered PrEP during routine maternal and child health and family planning services. AGYW were sampled from two groups (1) declined PrEP and had ≥1 sexual partner(s) of unknown HIV status and (2) initiated PrEP and reported having one HIV-negative partner. AGYW with HIV-negative partners initiated PrEP due to known or suspected infidelity. AGYW with partners of unknown HIV status recognized PrEP as a helpful HIV prevention tool, yet worried about partner reactions and prioritized avoiding uncomfortable or unsafe situations over PrEP. Among pregnant AGYW, the responsibility of motherhood and providing a future for one’s family, through staying healthy and remaining HIV-free, was a strong PrEP use motivator. Among AGYW who desired future motherhood, fears that PrEP could negatively impact fertility or reduce contraceptive effectiveness led to declining PrEP. Peers positively influenced PrEP decision-making, especially personally knowing a PrEP user. Strategies are needed to enhance messaging and delivery approaches that are tailored to AGYW, including peer-led strategies.

KEYWORDS:

• Pre-exposure prophylaxis
• PrEP
• HIV prevention
• women
• adolescents
• Africa

Acknowledgements

We would like to thank the study participants for their time and contribution, and the PrEP Implementation for Young Women and Adolescents (PrIYA) Program for their support in conducting this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was funded by a grant from the United States Department of State as part of PEPFAR’s DREAMS Partnership, managed by JSI Research & Training Institute, Inc. (JSI) and R01NR019220 by NIH grants. The opinions, findings, and conclusions stated herein are those of the authors and do not necessarily reflect those of the United States Department of State or JSI. This study was funded by the US National Institutes of Health (R01HD094630, R01HD100201, and R01AI125498). The PrEP Implementation for Young Women and Adolescents (PrIYA) Program was funded by the United States Department of State as part of the DREAMS Innovation Challenge (Grant # 37188–1088 MOD01), managed by JSI Research & Training Institute, Inc. The PrIYA Team was supported by the University of Washington’s Center for AIDS Research Behavioral Sciences Core (CFAR BSC) (P30 AI027757) and the Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh).