How can we help more young men access PrEP?

Expanding PrEP services to non-medical settings like high schools, colleges and community-based ‘youth zones’ could increase PrEP access among adolescent boys and young men, research from South Africa suggests.  

What is the research about? 

How to increase PrEP use among adolescent boys and young men in KwaZulu-Natal, South Africa. 

The study took place in uMgungundlovu district between 2021 and 2022. This is an area with high HIV prevalence where 23% of men aged 15-49 are estimated to have HIV. The study looked at 22 PrEP ‘delivery points’. These were 11 healthcare facilities, 2 high schools, 4 technical and vocational colleges and 5 community ‘youth-zones’. Youth zones are spaces run by community organisations for young people and focus on sexual and reproductive health and HIV.  

Just under 1100 sexually active young men (ages 15–35) took part in the study. All had come for an HIV test and were offered PrEP after testing negative. 

Why is this research important? 

South Africa has been offering PrEP to people most at risk of HIV since 2016. Adolescent boys and young men have not been categorised as a priority group for PrEP, despite experiencing a high HIV rate. As a result, limited research has been done on the things that will influence young men’s use of PrEP.  

Where PrEP is available can make a big difference to whether people will use it or not. For example, getting PrEP from a healthcare facility may be unpopular if people feel the facility will not provide them with privacy or confidentiality, or they may encounter long queues or judgemental staff. 

What did they find out? 

Only 13% of young men who were offered PrEP began taking it. This is despite more than three quarters (79%) being screened as being at high risk of HIV. Overall, 61% of participants said they would consider taking PrEP at some point. 

Among those who started taking PrEP, over three quarters (78%) got PrEP from a high school, 40% from a youth zone, 26% from a college and just 4% from a health facility.  

The study did not address the factors that influenced participants’ decisions. These findings will be published separately. However, not wanting to take drugs for a long time, fearing side effects, and not feeling at risk of HIV were the top three reasons given for not considering taking PrEP. 

What does this mean for HIV services? 

To increase PrEP use among adolescent boys and young men a mix of approaches is needed.  

There is a clear need for non-stigmatising, age-appropriate information about HIV risk and PrEP to encourage more young men to consider PrEP as an HIV prevention option. This information should be given in a language and tone that adolescent boys and young men in your location will understand, respond to and trust. It could be provided in a number of ways, including by sharing online content from Be In the Know (see our HIV prevention pages as a good place to start). Information about PrEP could also be shared by peer educators within schools or social spaces.  

The fact that healthcare facilities had lower rates of PrEP uptake than high schools, colleges and youth zones also shows how important it is to provide PrEP in non-medical spaces. The first step is to work with adolescent boys and young men to find out where would be most convenient for them to learn about PrEP and to collect PrEP prescriptions and refills. Young men’s reasons for not wanting to take PrEP also need to be better understood.