An exploration of the social-cultural factors that influence oral pre-exposure prophylaxis uptake and integration into sexual and reproductive healthcare services for young women in KwaZulu-Natal.

Abstract

In the past, HIV prevention efforts have disappointingly focused on reducing individual risk, with insufficient attention to socio-cultural, economic, structural, and other contextual factors that increase vulnerability to HIV. However, public health efforts towards HIV prevention now focus on combination strategies. This strategy recognizes that the integration of biomedical, social and structural interventions in mitigating the HIV and AIDS epidemic will translate to population-level impact. In Southern Africa, young women are disproportionately vulnerable to HIV infection, with women between the ages of 15 to 24 twice more likely to be infected than men. However, the licensure of oral pre-exposure prophylaxis (PrEP) and the South African National Department of Health policy on the integration of oral PrEP in sexual reproductive health (SRH) services creates renewed hope for young women who are often unable to negotiate safe sex practices. Nevertheless, the effectiveness of biomedical technologies is influenced by socio-cultural, structural and economic factors. This underscores the need to understand; (a) Populations that will consider using oral PrEP, (b) The likely socio-cultural challenges or opportunities that will influence acceptance, uptake and adherence of oral PrEP, and (c) How to integrate oral PrEP in already existing SRH services in a manner that ensures optimal adherence to oral PrEP to key population groups. This study sought to find effective ways in which oral PrEP can be integrated into SRH services in South Africa, KwaZulu-Natal (KZN). To attain an in-depth understanding of this topic, participatory visual methodologies in the form of journey mapping workshops and one-on-one interviews with 15 young women taking oral PrEP were facilitated. The participatory approach to this inquiry created an enabling space for young women to engage in dialogue about oral PrEP. Young women need to be placed at the centre of the response to HIV and AIDS in a meaningful way that will facilitate sustainable interventions in the fight against HIV and AIDS. Two nurses from both research sites were also interviewed to yield healthcare providers perspectives into the study inquiry. The study has the potential to inform policymakers on how existing SRH services can be improved to multi-dimensional systems that support oral PrEP uptake and adherence by young women at high risk of HIV. Findings of this study support the conclusion that oral PrEP needs to be integrated into already existing SRH services in ways that are context-specific and culturally relevant for communities. The young women in this study explicitly shared the various social and cultural factors that will influence them accessing oral PrEP in SRH services within their local clinics. Issues related to the structure, services offered and healthcare provider’s attitudes will affect acceptance, uptake and adherence of oral PrEP by young women in rural and urban KZN communities.