Background: Little is known about parents'' perceptions towards oral pre-exposure prophylaxis (PrEP). Yet, parental consent is necessary for adolescents to access sexual and reproductive health services in many sub-Saharan African countries and parents can be a key influence in AGYW''s access and use of health services. We explored how social norms and gendered parenting roles might influence parental support of AGYW''s PrEP use in Tanzania.
Methods: We conducted 4 focus group discussion (FGDs) (n=28) with female parents and 4 FGDs (n=27) with male parents in Mbeya and Dar Es Salaam in May 2017. To acquaint parents with PrEP, a visual, standardized script of PrEP information and placebo pills was shared with participants prior to FGDs. Interviewers then explored PrEP perceptions and factors influencing parental support of PrEP use. Thematic content and constant comparative analyses were used.
Results: We found overwhelming support among parents for PrEP availability for AGYW. Further, parents noted strong support for AGYW''s PrEP use, recognizing AGYW''s high risk of HIV due to limited power to negotiate preventative behaviors and frequent violence in sexual relationships. However, social norms around adolescent sexuality influenced parental support. Parents were wary of being viewed as condoning pre-marital sexual activity, while they worried that AGYW could be stigmatized as promiscuous. Further, respondents noted differential parenting roles of mothers versus fathers, which would influence the type of support they would be able to provide to AGYW. Men, in particular, noted shame and embarrassment in communicating with their daughters about relationships and sex.
Despite these concerns, parents expressed a willingness to support AGYW access to PrEP and sought strategies for supporting their daughters. Female parents described creating a supportive environment for PrEP use (e.g., ensuring AGYW has good diet) while male parents described offering logistical and material support (e.g., providing transport to health centers).
Conclusions: Programmers may need to consider the role of parents when designing programs to support AGYW''s PrEP use. Addressing social norms that hinder parental support of PrEP, and enhancing parents'' ability to communicate effectively with AGYW about sexuality, HIV risk, and PrEP - may be avenues to engage and garner parental support.