Peer-reviewed article
Creating allies: qualitative exploration of young women's preferences for PrEP methods and parents' role in PrEP uptake and user support in urban and rural Zambia.
Christina Misa Wong, Tendai Munthali, Featherstone G Mangunje, Mercy L Katoka, Holly M Burke et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study explored how young women aged 15-24 in Zambia view different HIV prevention methods (PrEP) and examined the role parents could play in supporting their use. Young women preferred injectable PrEP because it is discreet and longer-lasting, but many could not tell their parents about using it due to cultural beliefs against premarital sex. Both young women and parents wanted to talk about HIV prevention but faced barriers from cultural and religious norms, though parents recognized the real threat of HIV.
Key points
- Most adolescent girls and young women preferred injectable PrEP over the PrEP ring and oral PrEP due to its discreet nature and longer duration
- Many young women could not disclose PrEP use to parents because of cultural taboos against premarital sex and lack of perceived parental support
- Despite current non-engagement, both parents and young women expressed willingness to discuss HIV prevention and PrEP together
- Parents cited cultural and religious beliefs about abstinence as barriers to discussing HIV prevention with their daughters, but acknowledged HIV as a real threat
- The study recommends programs address social norms, provide communication skills, and conduct community sensitization to enable parent-child engagement on HIV prevention
Limitations
This is a qualitative study based on focus group discussions and interviews, which captures perceptions and preferences but cannot measure actual PrEP uptake, adherence, or effectiveness. The findings are specific to Zambia's cultural and religious context and may not generalize to other settings.
Abstract
BACKGROUND: Zambian adolescent girls and young women (AGYW) have high HIV incidence and face barriers to the use of pre-exposure prophylaxis (PrEP). Parental support improves PrEP use and adherence in some settings, but negative parental attitudes toward HIV prevention may inhibit engagement with AGYW. We explored perceptions of future PrEP methods among AGYW and parents and parent-youth engagement on HIV prevention and PrEP use. METHODS: We conducted a qualitative descriptive study among AGYW and parents of AGYW in five provinces in Zambia in September-October 2021. We conducted 10 focus group discussions (FGDs) and four in-depth interviews (IDIs) with AGYW participants (n = 87) and seven FGDs and four IDIs among parents of AGYW (n = 62). All FGDs and IDIs were audio-recorded, transcribed verbatim, and analyzed to identify qualitative themes. RESULTS: Most AGYW participants preferred the discreet nature and longer duration of injectable PrEP compared to the PrEP ring and oral PrEP. Many AGYWs reported inability to disclose PrEP use to their parents due to lack of parental support based on cultural taboos against premarital sex. Nevertheless, AGYW participants said they would like to talk to their parents about PrEP so their parents could support their use. Many parents also described difficulties discussing PrEP with their daughters because of cultural and religious beliefs about abstinence from sex before marriage. However, parents acknowledged that the threat of HIV is real and said they need PrEP knowledge and guidance on speaking with their children about HIV prevention and PrEP. CONCLUSIONS: Although many parents are currently not playing a role in daughters' decisions about PrEP use, both parents and AGYW are willing to engage with each other on HIV prevention issues. To foster parent-child engagement, HIV prevention programs should not only provide information about PrEP but also address social norms that impede discussion of HIV prevention and equip both parents and AGYW with skills and support for such conversations. Community sensitization is also needed as new PrEP products are introduced, to create an enabling environment for parent-child engagement by increasing awareness, countering misconceptions, and reducing stigma.