Examining facilitators, barriers, and social support in PrEP uptake and utilization for young African women: implications for HIV prevention

BACKGROUND: Adolescent girls and young women (AGYW) in sub-Saharan Africa experience disproportionately high HIV incidence, making pre-exposure prophylaxis (PrEP) a critical prevention strategy. While perceived HIV risk is known to influence PrEP initiation and continuation, the role of social support in shaping PrEP use among AGYW remains insufficiently understood. METHODS: This study presents a secondary analysis of qualitative interview data collected as part of HPTN 082, an open-label PrEP trial conducted between 2016 and 2018 in Harare, Zimbabwe, and Cape Town and Johannesburg, South Africa. Participants were offered daily oral PrEP (tenofovir disoproxil fumarate/emtricitabine). Sixty-seven AGYW aged 16-24 were purposively sampled from the parent cohort of 426 participants, all of whom were identified as being at high risk for HIV using an empiric risk score. Participants completed in-depth interviews at 13 and/or 26 weeks following study enrollment and PrEP initiation. Interviews explored motivations for PrEP use, experiences of adherence, and social influences. Analysts conducted thematic analysis to examine how social support and perceived HIV risk shaped PrEP initiation, adherence, and discontinuation. RESULTS: Three interconnected themes emerged: (1) multidimensional social support influencing PrEP adherence, (2) stigma, privacy constraints, and constrained adherence, and (3) perceived HIV risk as a key motivator for PrEP initiation and continuation. Emotional, instrumental, informational, and normative forms of support facilitated adherence in some contexts, while stigma, anticipated judgment, and limited privacy within households led to concealment, missed doses, and discontinuation in others. Perceived HIV risk, particularly related to partner infidelity or uncertainty, motivated PrEP initiation and persistence despite social barriers. CONCLUSIONS: Social support operates as a dynamic, double-edged influence on PrEP use among AGYW, simultaneously enabling and constraining adherence, depending on relational and structural contexts. Interventions that integrate stigma reduction, household- and community-level education, and strategies supporting autonomy and disclosure decision-making may improve sustained PrEP use. Addressing both social dynamics and risk perception remains critical to strengthening HIV prevention efforts.