“It makes me free”: participant perspectives on HIV prevention and contraception delivery at hair salons in Durban, South Africa

Oral pre-exposure prophylaxis (PrEP) use is low among women, particularly in South Africa (SA), where HIV incidence remains high. Providing integrated HIV prevention with other sexual and reproductive health (SRH) services in community settings may promote uptake and engagement. Hair salons are associated with wellbeing and offer a unique, community-based venue to deliver services. We sought to characterize participant experiences following a pilot intervention of integrated HIV prevention and SRH services in hair salons. We conducted in-depth individual interviews ( N = 56) with female participants, stylists, and salon owners (≥ 18y) following a 12-month pilot in hair salons in Durban, SA. Participants were offered a choice of oral PrEP, contraception, and STI services. Interviewees were asked about their experiences receiving care at the salon and hypothetical preferences for PrEP modalities. Stylists and owners were asked about the impact on business. Interviews were held in isiZulu and translated to English by bilingual study staff during transcription. Two research assistants (based in the US and South Africa) coded transcripts and conducted descriptive analysis. Participants reported high levels of satisfaction with salon-based SRH service delivery. Participants often noted the convenient, accessible location and non-judgmental atmosphere of the salon. Efficient service, multi-month oral PrEP and contraception dispensing, and appointment reminders were also cited as enhancing retention in the study. Some reported initial concerns about the legitimacy of salon-based offerings. However, explanations by staff alleviated skepticism. Most women felt privacy was adequate; however, some had concerns about confidentiality during counseling. Participants expressed enthusiasm about injectable PrEP if introduced in salons and suggested additional health services for integration into salon-based care. Hair salons are acceptable and accessible locations for SRH service delivery and offer an alternative to clinic-based care in SA. The hair salon venue may encourage regular attendance, as women feel motivated to return to a familiar community setting. Addressing concerns about legitimacy and privacy will be critical for successful, scaled implementation. Enthusiasm for injectable PrEP demonstrates high potential for hair salons to provide a variety of PrEP modalities, which is key to addressing individual preferences and optimizing HIV prevention. NCT04222504. Registered 2020-01-07.