Why focusing on family could help increase young people’s PrEP use

South African research has found that families play a critical role in whether a young person will keep taking PrEP, suggesting that focusing on the family could be a good way to improve adherence.

What is the research about?

Researchers interviewed 50 adolescents and young people aged 18-24 who were involved in PrEP trials in two urban townships in Cape Town, South Africa.

They did this to examine the ways in which families influence adolescents and young people to keep or to stop using PrEP.

Why is this research important?

Several PrEP trials in Southern Africa have found that young people have been reluctant to use PrEP or have tried it for a short while then stopped taking it, despite being at a high risk of getting HIV.

Understanding why this is and how it can be addressed could help improve HIV prevention efforts.

One way to do this is to look at the experiences a young person has in their own family when they take PrEP because families have a lot of influence on young people.

What did they find out?

1: Talking to family to get support

It can be emotionally and practically difficult to take PrEP in secret. Many young people said that taking PrEP became easier once their family knew about it, especially if they reacted in a supportive way.

Participants described various ways family members helped them to keep taking PrEP once they had told them about it. This included reminding them to take their PrEP pills or about clinic appointments, taking messages about follow-up visits and being emotionally encouraging.

2: Negative reactions

But some participants received unsupportive reactions from their families about taking PrEP. They were judged, misunderstood or labelled as having HIV and lying about being on HIV treatment. Using PrEP remained a challenge for these young people.

Some said their family’s negative reaction increased the practical difficulties of taking PrEP, for example, because a family member had thrown away their PrEP pills. Others were constantly questioned about why they were using PrEP when they were not sick.

These negative reactions could make young people feel more doubt or mistrust about taking PrEP. This was particularly the case when misinformation that PrEP was bad for your health was also circulating in the community, or when family members lacked information about PrEP.

3: Family dynamics

Researchers found that the type of relationship within families influenced whether young people would get a positive or negative reaction about using PrEP.

In families where young people had close relationships with parents and other family members and were able to discuss sensitive issues like sex, they felt more comfortable talking about PrEP and were more likely to get support for taking it.

But in families where open communication was limited or did not exist, it was harder for young people to talk about using PrEP and to keep using it. In these cases, young people were more likely to rely on themselves, friends or partners for support.

What does this mean for HIV services?

These findings show that the family plays an important role in whether a young person will use PrEP or not – and in other matters relating to sexual health.

If you are working on PrEP or other sexual health programmes for adolescents and young people, it is worth considering engaging with some young people’s families. But remember, it will be essential to get the consent of any young person you are working with before you reach out to their family. And each young person should decide whether to share information on their PrEP use, or any other details about their sexual health, to their family.

Understanding whether a young person has a supportive and open relationship with their family could be a useful starting point. Young people in these situations could take part in training with their families on how best a family can support a young person to use PrEP.

It will also be equally important to identify the young people who are unlikely to receive family support for using PrEP. You could ask these young people to think about where else they could get support from, and run sessions for them on how to deal with difficult situations that may arise in their family if they decide to use PrEP.