Caring, non-judgemental staff are the “magic ingredient” of youth-friendly HIV services

The importance of training sexual healthcare providers to be caring and non-judgemental towards young people has been highlighted by PrEP research in South Africa. Young women in the study said that feeling cared for by staff kept them coming back for refills and other services. 

What is the research about? 

The research looked at what parts of a ‘youth-friendly’ PrEP adherence scheme for adolescent girls and young women were the most useful. 

The Community PrEP Study offered HIV-prevention empowerment counselling to a group of young women (ages 16-25) in rural and suburban areas of Eastern Cape Province. This gave young women tools, knowledge and support for using PrEP, focusing on motivation, risk-reduction and behaviour. Sessions were either one-on-one or in a peer group.  

Another group of young women got standard PrEP refill services. This included basic education about the benefits of PrEP, how to take it and potential side effects.  

All participants were able to chat with study staff. When they got their monthly PrEP supply, they also got a pill box, chips and juice, menstrual pads and condoms.  

To find out what parts of the scheme mattered the most, researchers interviewed 39 young women across both groups, plus seven study staff. 

Why is this research important? 

In Africa, adolescent girls and young women are at significant risk of HIV. PrEP is proven to prevent HIV infection, and South Africa has been offering it to young women since 2020. But many young women struggle to stay on PrEP. To change this, finding out what could help young women adhere is important.  

What did they find out? 

Participants in both groups said that the friendly, non-judgmental, non-stigmatising study staff were the most important part of the PrEP service.  

Many were pleasantly surprised by staff’s attitudes. Some described how staff in public clinics would judge or shout at them for being sexually active. As one young women said: “It was more than what I was expecting… When you talk to them you can feel there is a healing …”  

Participants viewed the staff more as friends or big sisters. They felt they could talk openly to them about all parts of their lives, and they wouldn’t be punished or shamed.  

Staff tried to avoid judging participants if they missed visits or didn’t adhere to PrEP. This helped to build trusting relationships. As one staff member said: “Even if [you] miss your date for like two or three months […] we are happy that you have come.” 

Staff also made a point to let young women know that “whatever we are saying in the room will stay there”. This also helped to build trust because young women felt that their privacy would be protected.  

Many participants lacked access to menstrual hygiene products, food and the internet, so these resources also encouraged them to keep coming to facility. 

Participants who had the empowerment counselling said it was helpful, particularly for finding ways to tell others they were using PrEP.  

What does this mean for HIV services? 

Although the empowerment counselling did have additional benefits, it was the presence of staff who the young women could trust, who didn’t judge them, and who cared about their lives that mattered the most. 

This is an important finding. It shows that the way staff conduct themselves is a big factor in whether young people will use a sexual health service and keep using it. This is not only relevant for PrEP refills but for things like regular STI or HIV testing and regular condom or birth control pick-ups. 

If you are providing sexual and reproductive healthcare for young people, training staff to be respectful and caring should be a main priority.  

Providers should know how to relate to young people in a way that makes them feel seen and heard. Using PrEP should be framed as something positive that young people can do to take responsibility for their health. Young people who use PrEP should be encouraged rather than shamed. Training should also cover how to ensure privacy and confidentiality.  

Providing material things like free internet and menstrual products and keeping waiting times to a minimum might also help young people to attend.