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Multi-level Factors Driving Pre-exposure Prophylaxis Non-initiation Among Young Women at High Risk for HIV in Kenya

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Abstract

Few studies have focused on understanding pre-exposure prophylaxis (PrEP) non-initiation among young, high-risk women in sub-Saharan Africa. This study aimed to qualitatively explore why young women in Kenya at high-risk for HIV chose not to enroll in a PrEP adherence trial. We performed 40 semi-structured interviews with young high-risk women assessing concerns about PrEP and/or study participation. We also assessed community-level factors influencing decision-making around PrEP through 10 focus groups involving peers, young men, caregivers, and community leaders. Our qualitative data reflect the complexity of navigating barriers preventing PrEP initiation in settings where taking PrEP may be perceived as immoral behavior. Framed within the context of risk perception, the decision to start PrEP may run counter to the potential risk of losing support from one’s community. Our findings suggest that approaches addressing social norms, while de-medicalizing HIV prevention services, are needed to further increase PrEP uptake among young Kenyan women.

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Data Availability

The datasets during and/or analyzed during the current study cannot be made publicly available to maintain participant confidentiality.

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Funding

We thank the individuals who participated in this study and the broader study team. The parent grant (MPYA) was supported by the National Institute of Health (NIH) under Grant R01MH109309 (PIs: Haberer and Baeten) as was the R01 Supplement that supported this research.

Author information

Author notes

  1. Yeonsoo S. Lee

    Present address: Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA

  2. Chiemelie Anyacheblu

    Present address: SUNY Downstate Medical Center, Brooklyn, NY, USA

  3. Jared M. Baeten

    Present address: Gilead Sciences, Foster City, CA, USA

Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Ingrid T. Katz, Yeonsoo S. Lee & Maria F. Nardell

  2. Harvard Medical School, Boston, MA, USA

    Ingrid T. Katz, Maria F. Nardell & Jessica E. Haberer

  3. Massachusetts General Hospital Center for Global Health, Boston, MA, USA

    Ingrid T. Katz, Lindsey E. Garrison & Jessica E. Haberer

  4. Harvard Global Health Institute, Cambridge, MA, USA

    Ingrid T. Katz

  5. Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

    Kenneth Ngure

  6. Kenya Medical Research Institute, Nairobi, Kenya

    Kevin Kamolloh, Vallery Ogello, Moses Okombo, Nicholas B. Thuo, Esther Owino, Elizabeth Bukusi & Nelly Mugo

  7. Harvard T.H Chan School of Public Health, Boston, MA, USA

    Chiemelie Anyacheblu

  8. Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

    Elizabeth Bukusi

  9. Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA

    Nelly Mugo & Jared M. Baeten

  10. Division of Women’s Health, Brigham and Women’s Hospital, 1620 Tremont St. – 3rd Floor, Boston, MA, 02120, USA

    Ingrid T. Katz

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Table 5 Consolidated Criteria for Reporting Qualitative Studies (COREQ): 32-item checklist
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Katz, I.T., Ngure, K., Kamolloh, K. et al. Multi-level Factors Driving Pre-exposure Prophylaxis Non-initiation Among Young Women at High Risk for HIV in Kenya. AIDS Behav 27, 106–118 (2023). https://doi.org/10.1007/s10461-022-03748-9

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