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Background: Very few studies have been conducted with AGWY in Tanzania and South Africa on motives for initiating PrEP. We conducted a qualitative sub-study as part of the EMPOWER study, which evaluates the feasibility and acceptability of offering oral PrEP alongside an HIV and violence prevention package for AGYW in South Africa and Tanzania.
Methods: In-depth interviews were conducted with participants 3 months after accepting PrEP in Johannesburg (n=25) and Mwanza (n=14). Data were transcribed and translated into English and coded in QSR Nvivo taking an inductive thematic approach. Key themes relating to participants┬┤ motives for PrEP-use were elicited.
Results: In Mwanza, participants were working in bars or as local food vendors where sexual transactions are common. They acknowledged the higher HIV risk of their work environment but also were concerned about regular partners'' infidelity. Initial concerns about PrEP safety were assuaged following receipt of product information from study staff. Motives also focused on ''being safe'', and that using PrEP would offer them reliable HIV protection in contrast to condoms.
Participants in Johannesburg were students in the inner-city, a social context where multiple concurrent partnerships are the norm. Virtually none trusted their partners, who were considered promiscuous and at high HIV-risk. Most participants recognised their risk was heightened by low condom use and cited fear of sexual assault. In both sites, experiences of family living with HIV and dying of AIDS also motivated women to use PrEP.
Conclusions: In both sites, motives for initiating PrEP reflected a desire to protect their health and future. In Mwanza, the main narrative was one of ''safety''; PrEP was considered a safe drug with high efficacy, reflecting trust in the research study context and confidence that HIV could be conquered. In Johannesburg, PrEP aligned with the ''independent, urban woman'', an aspiring image in this setting; participants understood PrEP does not guarantee efficacy in preventing HIV and had some safety concerns, but awareness of their heightened personal risk was greater.
Our study confirms the high acceptability of PrEP among two contrasting populations of African AGYW, but cautions that repeated messaging about multiple protection methods are still needed.