Abstract
Background: Young people aged 15 to 24 years make up the majority of Human Immunodeficiency Virus (HIV) positive people in South Africa, accounting for nearly half of all infected people. Women account for nearly 67% of all new infections. Young people especially adolescent girls and young women (AGYW) aged between 15-24 years old are vulnerable to HIV. According to researchers, people under the age of 25 account for half or more of all HIV infections in several developing nations. As a result, effective HIV prevention among youth is important to the epidemic's future trajectory and understanding sexual attitudes and behaviours of adolescents in terms of HIV risk is therefore critical. The aim of this is to identify the facilitating factors and barriers to PrEP uptake among adolescent girls and young women in the Free State Province's Thabo Mofutsanayana District (TMD).
Methods: The AGYW were invited to participant as they attended their routine clinic visits. The study included a total of 372 participants of which 196 AGYW were already on PrEP and 175 AGYW declined PrEP upon enrolment onto the DREAMS programme. Data were collected from study participants using a semi structured questionnaire, that includes questions on demographics, risk factors for HIV and STI's and questions on barriers and facilitators for PrEP uptake. The research study was undertaken in Thabo Mofutsanyana District (TMD) in the Free State in the following eight facilities, Harrismith, Bluegumbuch, Phuthaditjhaba, Boiketlo, Bolata, Namahali, Petsana and Rearabetswe clinic. The paper-based questionnaire was captured on google forms which is password protected, exported to excel for data clean-up and later imported to IBM SPSS version 29.0.
Results: a total of 372 AGYW were included in the study of which the highest PrEP uptake was found in the age group 20–24 years old, at 56.7% (n= 131), while the lowest uptake was found in the age group 18–19 years old, at 53.2% (n= 74). According to the findings, 83.1% of AGYW engage in sexual activity and 58.7% of them do not consistently use condoms, which is one of the main risk factors for HIV transmission. The overall PrEP uptake was 58.2% (n=196) and those who are sexually active 55.3% of them took up PrEP. Despite engaging in risky sexual behaviours like having multiple sexual partners (22.6%), not knowing their
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partner's HIV status (60%), having a history of STI treatment (22.3%), and being in transactional relationships (32.1%), a large percentage of AGYW (70.9%) do not believe they are at risk of contracting HIV. In the multivariable logistic regression model, none of the study's variables were found to be substantially correlated with PrEP uptake. Consequently, the study was unable to identify any variables that would encourage AGYW to use PrEP. The marketing of PrEP services to youth (cOR; 0.51; 95% CI: 0.13–2.02) is one of the barriers preventing young people from using PrEP, and it accounts for 0.51 of the participants' likelihood of doing so. PrEP was thought to be well-marketed by just 47.3% of respondents, while 52.7% disagreed. Concerning the mode of administration of PrEP, the findings indicated that 73.1% of participants disliked taking tablets, and the majority of participants (73,5%) would also not use PrEP if it were an injectable. Additionally, the results showed that, in contrast to 47.3% (n=175) of the respondents, 52.7% (195) of the respondents expressed doubt about their ability to remember to take the daily PrEP pill. To enhance PrEP uptake, more interactions with AGYW are necessary to learn about their preferred mode of PrEP administration. According to the study findings, 30,7% of AGYW still worry about stigma and discrimination from their community and would prefer that no one knew that they use PrEP or visit healthcare facilities.
Conclusion: The study's findings offer some suggestions for enhancing the district's preventive program and increasing PrEP uptake. The results of this study also imply that interactions with young people are still necessary in order to customize programs that will suit their needs. One major barrier to receiving prophylactic services is the perception of one's risk of HIV infection. By interacting with every relevant party, the department of health will be able to help AGYW and the general public recognize their personal risk of HIV infection and take the appropriate precautions to protect themselves and their partners.
Keywords: Adolescent girls and young women; HIV risk, and PrEP