A Socioecological Perspective to Understand Perceived Risks and Benefits of Oral Pre-exposure Prophylaxis Towards the Promotion of Combination HIV Prevention Strategies

Abstract

HIV incidence rates remain disproportionately high among adolescent girls and young women in Sub-Saharan Africa, where women are 5–7 times more likely to become HIV-infected than their male peers. Oral pre-exposure prophylaxis (PrEP), a first-generation licenced biomedical innovation, can benefit populations at substantial risk of HIV acquisition, with options for independent product use for women in vulnerable situations. However, adoption of new product innovations bears several complexities with limited product knowledge, product confidence and low perceptions of risk. This study utilizes a socioecological perspective to explore perceptions of HIV risk and perceived barriers or benefits of oral PrEP with a sample of adolescent girls and young women and young men in rural KwaZulu-Natal. A theory-driven data-informed analysis utilizing the Health Belief Model and participatory research was used to engage with both men and women from HIV high-burden districts. The study identified various levels of risk using the socioecological perspective and found a specific association among women of PrEP as assurance of lower risk of HIV infection, whereas men perceived PrEP as insurance for risky behaviour. Revisiting perceptions of risk in terms of risk profiles should be ongoing and this study highlights that strategic health communication is needed to increase understanding of HIV risk in order to promote PrEP as part of HIV combination prevention for those willing to adopt new health innovations.