Gender-specific awareness and acceptability of pre-exposure prophylaxis to prevent HIV infection among youth in western Kenya: Implications for combination HIV prevention

Youth ages 15-24 in sub-Saharan Africa are more impacted by HIV/AIDS than any other group globally. In Kenya, young females are 4-times more likely to be positive than males. Gender-specific HIV prevention combining behavioral, structural, and biomedical modalities is necessary to impact the epidemic. Trials of pre-exposure prophylaxis (PrEP) showed efficacy in reducing HIV risk when adherence >=85%. The study analyzed youth knowledge, acceptability, facilitators, and barriers to PrEP adherence, which influence intervention efficacy. Focus groups were conducted in Nyanza, Kenya composed of youth ages 15-24, parents and teachers of youth, and community, district, and religious leaders. Forty six females and 66 males participated (n=112). A content analysis identified themes and sub-themes related to PrEP. Four major themes emerged: (1) limited knowledge of PrEP as an HIV prevention method; (2) PrEP advantages; (3) concern about side-effects; (4) potential risk compensation. Sub-themes highlighted a desire for sensitization campaigns, the idea of PrEP as life saving, and adherence challenges. Findings indicate a need for increased PrEP awareness. Youth expressed willingness to use PrEP when coupled with pre-counseling and adherence support. Adherence to the PrEP is linked to knowledge, widespread use, and acceptability. Adherence remains a challenge with variability in access, risk-perceptions, and concerns about side-effects. Some participants believed HIV risk-reduction outweighed potential side-effects. Participants indicated PrEP could be effective for HIV prevention. Considering the efficacy of PrEP trials, combination HIV prevention studies should explore incorporating PrEP. Interventions need to provide gender-specific options to reduce PrEP misconceptions, reduce risk compensation, and support adherence.