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Qualitative Analysis Using Social Maps to Explore Young Women's Experiences With Social Support of their Oral PrEP Use in Kenya and South Africa

aimed to assess young women's uptake of and adherence to PrEP while developing scalable PrEP delivery strategies for African women in high HIV incidence settings A total of 2,550 AGYW (aged 16–25 years) enrolled in POWER between 2017 and 2020, at one of six clinics

Data collection

Wits researchers involved: Makhosazane Nomhle Ndimande-Khoza, Sinead Delany-Moretlwe Adolescent girls and young women (AGYW) are at disproportionate risk of HIV infection in subSaharan Africa, 79% of new infections among 10–19 year olds are in girls (UNAIDS, 2019). Preexposure prophylaxis (PrEP) is a highly effective HIV prevention method; yet, oral daily PrEP adherence is challenging for AGYW in sub-Saharan Africa, despite their desire to stay HIV-free.

Social barriers to AGYW PrEP uptake and use have been identified in previous HIV prevention studies, such as HIV- or sex-related stigma, low social support, or disapproval of using a female-controlled HIV prevention product from partners, family, peers, and healthcare workers Peer support and peer influence are important in terms of AGYW's sexual and reproductive health behaviour, as well as family support for AGYW's HIV

In this study, AGYW in South Africa and Kenya participated in a social mapping exercise as part of a focus group discussion (FGD), through which the nuance of various social influencer groups was explored This article explores AGYW's views on the impact of social influencers on their PrEP use and AGYW's perception of those influencers' PrEP knowledge and support during the study. An exercise with social network maps is used to identify the relative influence of various members of AGYW's social networks and explored the direction of that influence on PrEP use.

Methods

This analysis includes a subset of participants from two family planning clinics in Kisumu, Kenya, one adolescent-friendly clinic in Johannesburg, and a community mobile adolescent health clinic in Cape Town, South Africa Toward the end of the POWER accrual period, using convenience sampling, young women who attended any site activities or clinic visits were asked if they were willing to participate in an FGD To be eligible for the FGD, they had to have refilled at least one PrEP prescription since enrolling in the POWER study

Social Mapping Exercise

During the FGDs, participants were asked to complete a social mapping exercise They placed pre-labelled stickers of PrEP influencers on an egocentric circle map to indicate their strength of influence (i.e., from inner/most influential circle to outer/least influential circle Facilitators followed a semi-structured guide, which included questions about participants' sticker choices placed accordingly

Conclusion

Using an ego-centric social network mapping tool to explore the relative influence of multiple influencers at once, AGYW described key supporters and detractors of their PrEP use, such as mothers, clinic counsellors, sex partners, and best friends

Successful approaches to supporting PrEP use should include youth-friendly services and counselling, interventions to increase community awareness about PrEP, which would facilitate support from mothers and best friends, address partner concerns about PrEP, and reduce stigma. Such interventions could foster effective PrEP use among adolescents to maximize the public health impact and reduce AGYW HIV infections *Read the full study

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