I Don’t Think I Am at Risk Because I Still Use Condoms When I Can: Exploring Social Barriers to PrEP Uptake and Use Among Adolescent Girls Using Contraceptives in Berea, Lesotho

While notable progress has been made in preventing unintended pregnancies among adolescent girls in Lesotho, many remain vulnerable to HIV infection. As family planning services expand for young people through donor-funded projects, opportunities may exist to integrate HIV prevention, including Pre-Exposure Prophylaxis (PrEP) into contraceptive care. However, PrEP use among adolescent girls accessing family planning services remains low. This study explores the social barriers to PrEP uptake and adherence among adolescent girls who access conventional donor-funded family planning services, primarily designed to prevent unintended pregnancies. Qualitative data were collected from twelve adolescent girls using contraceptives located in Berea, Lesotho, through semi-structured one-on-one interviews. The study found that factors such as limited condom use, early sexual initiation, multiple partner relationships, and age-disparate relationships were often reasons for seeking family planning services to avoid unwanted pregnancies amongst adolescent girls. However, these same factors also coincide with increased HIV exposure, while fear of judgment, stigma, and perceived negative side effects discouraged them from using PrEP effectively to prevent infection. Additionally, there was a low perception of HIV infection risks amongst these adolescent girls, which further hampered PrEP uptake, potentially leaving them more vulnerable to HIV infection. Based on the findings, we argue that although donor-funded family planning services in Lesotho may contribute to reducing unintended adolescent pregnancies, the prioritisation of pregnancy prevention may leave gaps in comprehensive HIV prevention, particularly in PrEP uptake among contraceptive-using adolescents. This study demonstrates that the factors potentially leading adolescent girls to use contraceptives also coincide with factors associated with HIV vulnerability, contributing empirical insights into adolescent HIV prevention in Lesotho by foregrounding the intersection between contraceptive use and HIV vulnerability among adolescent girls.