Exploring social factors that inform the low uptake of PrEP among adolescent girls receiving family planning interventions from donor-funded projects in Berea, Lesotho

Abstract

Adolescent girls in Lesotho and other countries with high human immunodeficiency virus (HIV) prevalence need urgent action to increase enrolment in pre-exposure prophylaxis (PrEP), which remains low and limited. Studies reveal that many adolescent girls in Lesotho continue to fall pregnant unintentionally and are infected with HIV despite mitigation efforts by the government. For instance, the Government of Lesotho, in collaboration with other stakeholders, has enhanced the availability of sexual and reproductive health services in all 10 districts of the country and made family planning services accessible to adolescents aged 12 years and older without parental consent. However, there are concerns that such access to contraception might inadvertently undermine HIV prevention efforts. In Lesotho, little is known about how adolescent girls who use family planning services navigate the risk of HIV. Consequently, this study aimed to address this gap by examining the social factors that contribute to the low uptake of PrEP among adolescent girls who use family planning services in Berea, Lesotho, by employing the Health Belief Model and the Theory of Planned Behaviour theoretical framework. Using a purposive sampling approach, 12 adolescent girls aged 18 and 19 years were recruited to participate in the study. Data were generated through semi-structured face-to-face and telephonic interviews and were analysed using Braun and Clarke’s (2006) six-stage thematic analysis method. The findings demonstrate that social factors such as fear of stigma, conflating PrEP with antiretroviral therapy, and negative attitudes and beliefs towards PrEP discourage its use, lower the perceived HIV risk among adolescent girls, and reduce tolerance for possible side effects. This study makes recommendations to healthcare service providers to create safe spaces to reduce stigma and to avoid moralising language when developing health promotion messages that target peer and reference groups, as many adolescents tend to base their decisions on the opinions of their peers or significant others. The contribution this study makes to existing knowledge pertaining to adolescent health and HIV is that much of the feared stigma faced by adolescent girls is anticipated, and that stigma, whether anticipated or experienced, discourages the uptake of HIV prevention and treatment services or their continuation.