Background: Low uptake has limited the promise of PrEP as a HIV prevention tool among adolescent girls and young women (AGYW). To inform PrEP scale up in Kenya, through qualitative interviews, we sought to understand how young women arrived at a decision to start PrEP.
Methods: In two sites in Kenya, Kisumu and Thika, we enrolled 350 young women (18-24 years old) considered at high risk for HIV
... [Show full abstract] and who initiated oral PrEP. Using qualitative semi-structured in-depth interviews, we conducted 50 interviews at least one week after PrEP initiation. The goal of the interviews was to assess PrEP and HIV risk perceptions prior to and around PrEP initiation. Thematic analysis was done and concepts related to influencers relating to PrEP initiation were identified.
Results: Majority of the women reported initiating PrEP due to the fear of acquiring HIV infection and related HIV stigma. Risk factors for HIV infection were identified as selection of partners (single or multiple partners of unknown HIV status) and alcohol use. Sexual partner reluctance to use condoms or test for HIV created doubt about the partner’s HIV status and undermined trust. Information from health workers about PrEP being effective gave the women confidence to take it up. Peer PrEP users greatly influenced the decision to use PrEP, especially among young women housed together in hostels. “[…] she said that the drug is of help to her and she knew that she won’t get infected so that her future life can be good so I also told her that let me also come so that I can have a better future.” They also reported that they would use PrEP until they established that their partners were HIV uninfected. Young women who initiated PrEP felt reassured that it would protect them from HIV infection. Conclusions: Fear of HIV acquisition, coupled with self-evaluation of being at risk, health care worker and peer recommendation enhanced PrEP uptake. PrEP education and use of peers should be considered as part of demand creation for PrEP scale up among young women.