Risk and Readiness: Drivers of HIV PrEP interest among young women in high-burden rural South Africa
1
Health Economics and Epidemiology Research Office, Wits University, Johannesburg, South Africa
2
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
3
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
4
Africa Health Research Institute, Mtubatuba, KwaZulu Natal, South Africa
5
Institute for Global Health, University College London, London, United Kingdom
6
University of KwaZulu Natal, Durban, South Africa
7
Department of Global Health, Boston University, Boston, MA, United States
8
SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
9
Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Young women in sub-Saharan Africa remain disproportionately affected by HIV, yet how sexual behaviour, perceived risk, and risk-taking propensity shape decisions about HIV pre-exposure prophylaxis (PrEP) remains unclear. We examined associations between sociodemographic factors, self-reported sexual behaviours, perceived HIV risk, and risk-taking propensity with PrEP interest among young women in rural KwaZulu-Natal (KZN), South Africa.
METHODS:
We conducted a cross-sectional survey (July–November 2025) among women aged 18–30 years attending health promotion events in uMkhanyakude District, KZN. Behavioural HIV risk was measured using the VOICE risk score, self-perceived risk using the Perceived Risk of HIV Scale, and general risk-taking propensity using the Balloon Analogue Risk Task. Logistic regression models assessed associations with PrEP interest (somewhat/very interested vs. not at all).
RESULTS:
Among 250 participants (median age 22), socioeconomic vulnerability was common: 34.4% reported food insecurity and 59.6% struggled to afford healthcare. Sexual risk indicators were prevalent, including age-disparate partnerships (56.4%), no condom use at last sex (56.4%), current curable STIs (50%), transactional sex (14.4%), and secondary partners (20%). Nearly all participants (98.8%) were aware of PrEP and 54.4% were current users. Overall, 90.8% expressed interest in future or continued use, with similar preferences for daily oral PrEP (49.3%) and long-acting injectable cabotegravir (48.9%). In unadjusted analyses, having a secondary partner was associated with lower PrEP interest (OR 0.18; 95% CI 0.06-0.59), while ever engaging in transactional sex was associated with higher interest (OR 3.12; 95% CI 1.23-7.94). VOICE score, self-perceived HIV risk, and risk-taking propensity were not strongly associated with PrEP interest, including after adjustment.
CONCLUSIONS:
Established behavioural risk measures, perceived HIV risk, and general risk-taking propensity were weak correlates of PrEP interest. These findings suggest a disconnect between measured risk and demand, underscoring the need for PrEP strategies that address broader motivational, relational, and contextual drivers of uptake.
Young women in sub-Saharan Africa remain disproportionately affected by HIV, yet how sexual behaviour, perceived risk, and risk-taking propensity shape decisions about HIV pre-exposure prophylaxis (PrEP) remains unclear. We examined associations between sociodemographic factors, self-reported sexual behaviours, perceived HIV risk, and risk-taking propensity with PrEP interest among young women in rural KwaZulu-Natal (KZN), South Africa.
METHODS:
We conducted a cross-sectional survey (July–November 2025) among women aged 18–30 years attending health promotion events in uMkhanyakude District, KZN. Behavioural HIV risk was measured using the VOICE risk score, self-perceived risk using the Perceived Risk of HIV Scale, and general risk-taking propensity using the Balloon Analogue Risk Task. Logistic regression models assessed associations with PrEP interest (somewhat/very interested vs. not at all).
RESULTS:
Among 250 participants (median age 22), socioeconomic vulnerability was common: 34.4% reported food insecurity and 59.6% struggled to afford healthcare. Sexual risk indicators were prevalent, including age-disparate partnerships (56.4%), no condom use at last sex (56.4%), current curable STIs (50%), transactional sex (14.4%), and secondary partners (20%). Nearly all participants (98.8%) were aware of PrEP and 54.4% were current users. Overall, 90.8% expressed interest in future or continued use, with similar preferences for daily oral PrEP (49.3%) and long-acting injectable cabotegravir (48.9%). In unadjusted analyses, having a secondary partner was associated with lower PrEP interest (OR 0.18; 95% CI 0.06-0.59), while ever engaging in transactional sex was associated with higher interest (OR 3.12; 95% CI 1.23-7.94). VOICE score, self-perceived HIV risk, and risk-taking propensity were not strongly associated with PrEP interest, including after adjustment.
CONCLUSIONS:
Established behavioural risk measures, perceived HIV risk, and general risk-taking propensity were weak correlates of PrEP interest. These findings suggest a disconnect between measured risk and demand, underscoring the need for PrEP strategies that address broader motivational, relational, and contextual drivers of uptake.
| eISSN: | 2654-1459 |
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