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Uptake of HIV Prevention & Sexual and Reproductive Health Services Among Adolescent Girls & Young Women – the PrEPARE Pretoria Project

Addressing the urgent need for gender-focused and targeted HIV prevention among adolescent girls and young women in South Africa

This study is funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development grant R01 HD094629.

This study…encourages us youth of today about our health, behaviour and mental things & we should take care of our bodies.  This study encouraged me to become a better person in life and fulfil my goals and studies.” – AGYW Participant

The need for HIV prevention among adolescent girls and young women in South Africa

There is an urgent need for gender-focused and targeted HIV prevention efforts among adolescent girls and young women (AGYW) in South Africa, with one such measure being the use of pre-exposure prophylaxis, or PrEP. PrEP, when taken as prescribed, is a medicine that significantly reduces the chance of acquiring HIV. However, multiple factors need to be addressed to support AGYW initiation and uptake of PrEP, including addressing intersectional forms of stigma and discrimination (S&D) in clinics, and interpersonal factors at the individual level. Intersectional S&D towards AGYW is the convergence of multiple stigmatized identities, such as age, health, gender, behavior, and socioeconomic status. It is not only important to continue seeking out the best modes of HIV prevention among young women, but to also promote and implement comprehensive gender-focused biobehavioral interventions that address the whole clinic experience to remove as many barriers to HIV prevention as possible.

The PrEPARE Pretoria Project – Addressing HIV prevention & uptake of sexual and reproductive health services for AGYW

The PrEPARE Pretoria project is an adaptation of the Young Women’s Health CoOp, which addresses substance use, sexual risk, violence prevention and sexual negotiation, condom demonstration, and problem solving with the following additions: knowledge of PrEP, the importance of PrEP adherence, and sexual and reproductive health (SRH). The adapted Young Women’s Health CoOp emphasizes empowerment and decision making for AGYW, and also aims to educate participants about types of birth control that may be available to them in South Africa.

This adaptation further incorporates a structural level intervention with S&D reduction trainings in clinics to address barriers to accessing SRH services among this population. The stigma reduction training is adapted from the Health Policy Project (HPP) HIV-Stigma and Discrimination reduction training curriculum based on a decade of implementation experience in 9 countries in Africa, South and Southeast Asia, and the Caribbean.

Specifically, PrEPARE Pretoria seeks to determine whether implementing a multilevel, woman-focused intervention for PrEP readiness, uptake, and adherence among AGYW aged 16 to 24 who engage in high-risk sexual behaviors in Tshwane, South Africa, that includes S&D reduction assessment and training in clinics, is a viable complement to South Africa’s National Strategic plan for HIV, which includes a focus on AGYW.

The impact of the PrEPARE Pretoria project

The PrEPARE Pretoria project is ongoing and has successfully continued during the COVID pandemic.  This project has several outlined intended impacts and measurements:

  • Reduced stigma and discrimination towards AGYW by clinic staff (The S&D reduction training has been implemented in all the clinics randomized to receive this training)

The PrEPARE training was so important because I learned lots of things about stigma. I am now able to be a better professional at work because of PrEPARE.” 

– Clinic Staff, S&D Workshop (March 2020)

  • AGYW PrEP uptake and adherence
  • Uptake of SRH services
  • Reductions in AGYW’s experienced interpersonal violence, substance use, and high-risk sexual behaviors
  • Increased problem solving and communication skills among AGYW