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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
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
0954-0121
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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Chimbindi, Natsayi
c518d13f-6c0b-4eb2-92f5-89d260eeba87
Mthiyane, Nondumiso
e47691b1-0dcc-4699-b77b-e3b13748fa77
Zuma, Thembelihle
4e18a669-385a-4664-85dc-7f8d16ea8539
Baisley, Kathy
5fe8c276-d9d2-4bb6-91a3-8acd38a5151f
Pillay, Deenan
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Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Harling, Guy
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Sherr, Lorraine
dcc07842-49e3-44fc-bf87-d56dd0f15323
Birdthistle, Isolde
de32dd88-7206-4bc3-9cb9-b86f15707cfa
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
d88581c9-0ef2-4506-b8d3-d72682936a09

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. (doi:10.1080/09540121.2021.1902933).

Record type: Article

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
Restricted to Repository staff only until 26 May 2022.
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More information

Accepted/In Press date: 9 March 2021
e-pub ahead of print date: 26 March 2021
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: 0954-0121
PURE UUID: 1d44f876-dfca-4745-a72e-dc1bf34492f2
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

Catalogue record

Date deposited: 21 May 2021 16:31
Last modified: 26 Nov 2021 03:00

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Contributors

Author: Natsayi Chimbindi
Author: Nondumiso Mthiyane
Author: Thembelihle Zuma
Author: Kathy Baisley
Author: Deenan Pillay
Author: Nuala Mcgrath ORCID iD
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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