Antiretroviral therapy based HIV prevention targeting young women who sell sex: a mixed method approach to understand the implementation of PrEP in a rural area of KwaZulu-Natal, South Africa
Antiretroviral therapy based HIV prevention targeting young women who sell sex: a mixed method approach to understand the implementation of PrEP in a rural area of KwaZulu-Natal, South Africa
Pre-Exposure Prophylaxis (PrEP) is a potential game-changer for HIV. We used PrEP introduction for Young Women Who Sell Sex (YWSS) in a rural South Africa district to understand community norms and PrEP coverage in YWSS. Between 2017 and 2018, we measured awareness and uptake of PrEP in a representative cohort of 2184 Adolescent Girls and Young Women (AGYW) aged 13–22. We conducted group discussions with young people and community members (19); key informant interviews (9), in-depth interviews with 15–24 year-olds (58) and providers (33). Interviews were analysed using thematic analysis. PrEP awareness increased from 2% to 9%. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4%–15.7%) reported transactional sex and 10.6% (95%CI: 8.85–12.7%) sex for money. Of the 194 YWSS, 21 were aware of PrEP, but none had used it. Youth were enthusiastic about PrEP as tool for HIV prevention; whilst older community members were cautious about a technology they had limited experience with but could benefit select groups. Teachers and healthcare providers were concerned that PrEP would lower personal responsibility for sexual health. In conclusion, the narrow and limited introduction of PrEP to YWSS reduced the accessibility and reach. Introducing PrEP as part of sexual healthcare may improve demand and access for YWSS.
Access framework, HIV prevention interventions, acceptability, adolescents, female-sex workers, pre-exposure prophylaxis (PrEP), young women who sell sex
Chimbindi, Natsayi
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Mthiyane, Nondumiso
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Zuma, Thembelihle
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Baisley, Kathy
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Pillay, Deenan
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Mcgrath, Nuala
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Harling, Guy
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Sherr, Lorraine
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Birdthistle, Isolde
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Floyd, Sian
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Dreyer, Jaco
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Nakasone, Sarah
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Seeley, Janet
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Shahmanesh, Maryam
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26 March 2021
Chimbindi, Natsayi
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Mthiyane, Nondumiso
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Zuma, Thembelihle
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Baisley, Kathy
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Pillay, Deenan
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Mcgrath, Nuala
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Harling, Guy
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Sherr, Lorraine
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Birdthistle, Isolde
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Floyd, Sian
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Dreyer, Jaco
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Nakasone, Sarah
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Seeley, Janet
f3106c01-ac91-4ffc-945a-6db3558fd8eb
Shahmanesh, Maryam
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Chimbindi, Natsayi, Mthiyane, Nondumiso, Zuma, Thembelihle, Baisley, Kathy, Pillay, Deenan, Mcgrath, Nuala, Harling, Guy, Sherr, Lorraine, Birdthistle, Isolde, Floyd, Sian, Dreyer, Jaco, Nakasone, Sarah, Seeley, Janet and Shahmanesh, Maryam
(2021)
Antiretroviral therapy based HIV prevention targeting young women who sell sex: a mixed method approach to understand the implementation of PrEP in a rural area of KwaZulu-Natal, South Africa.
AIDS Care : Pyschological and socio-medical aspects of AIDS/HIV.
(doi:10.1080/09540121.2021.1902933).
Abstract
Pre-Exposure Prophylaxis (PrEP) is a potential game-changer for HIV. We used PrEP introduction for Young Women Who Sell Sex (YWSS) in a rural South Africa district to understand community norms and PrEP coverage in YWSS. Between 2017 and 2018, we measured awareness and uptake of PrEP in a representative cohort of 2184 Adolescent Girls and Young Women (AGYW) aged 13–22. We conducted group discussions with young people and community members (19); key informant interviews (9), in-depth interviews with 15–24 year-olds (58) and providers (33). Interviews were analysed using thematic analysis. PrEP awareness increased from 2% to 9%. Among 965 AGYW sexually-active by 2018, 13.4% (95%CI: 11.4%–15.7%) reported transactional sex and 10.6% (95%CI: 8.85–12.7%) sex for money. Of the 194 YWSS, 21 were aware of PrEP, but none had used it. Youth were enthusiastic about PrEP as tool for HIV prevention; whilst older community members were cautious about a technology they had limited experience with but could benefit select groups. Teachers and healthcare providers were concerned that PrEP would lower personal responsibility for sexual health. In conclusion, the narrow and limited introduction of PrEP to YWSS reduced the accessibility and reach. Introducing PrEP as part of sexual healthcare may improve demand and access for YWSS.
Text
PrEP Paper Main Document_26Feb2021_resubmitted
- Accepted Manuscript
More information
Accepted/In Press date: 9 March 2021
e-pub ahead of print date: 26 March 2021
Published date: 26 March 2021
Additional Information:
The impact evaluation of DREAMS is funded by the Bill and Melinda Gates Foundation (OPP1136774, http://www.gatesfoundation.org). Foundation staff advised the study team, but did not substantively affect the study design, instruments, interpretation of data, or decision to publish. The research leading to these results has received funding from the People Programme (Marie Curie Actions) of the European Union’s seventh Framework Programme FP7/2007-2013 under REA grant agreement no. 612216 and the National Institutes of Health under award number 5R01MH114560-03. Africa Health Research Institute is supported by core funding from the Wellcome Trust [Core grant number (082384/Z/07/Z)]. NMcG is a recipient of an NIHR Research Professorship award (Ref: RP-2017-08-ST2-008). GH is supported by a fellowship from the Wellcome Trust and the Royal Society (210479/Z/18/Z). All the funding bodies had no role in the design of the study, and collection, analysis and interpretation of data and in writing of the manuscript.
Keywords:
Access framework, HIV prevention interventions, acceptability, adolescents, female-sex workers, pre-exposure prophylaxis (PrEP), young women who sell sex
Identifiers
Local EPrints ID: 449277
URI: http://eprints.soton.ac.uk/id/eprint/449277
ISSN: 1360-0451
PURE UUID: 1d44f876-dfca-4745-a72e-dc1bf34492f2
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Date deposited: 21 May 2021 16:31
Last modified: 17 Mar 2024 06:34
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Contributors
Author:
Natsayi Chimbindi
Author:
Nondumiso Mthiyane
Author:
Thembelihle Zuma
Author:
Kathy Baisley
Author:
Deenan Pillay
Author:
Guy Harling
Author:
Lorraine Sherr
Author:
Isolde Birdthistle
Author:
Sian Floyd
Author:
Jaco Dreyer
Author:
Sarah Nakasone
Author:
Janet Seeley
Author:
Maryam Shahmanesh
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