Correlates of willingness to use pre-exposure prophylaxis (PrEP) among young people impacted by HIV in Uganda
AIDS Care
Authors: Anita Kabarambi, Abel Zemedkun Girma, Portia Nartey, Imelda Nabbosa, Samiri Jamiru, Proscovia Nabunya, and Fred M. Ssewamala
This study examined factors associated with willingness to use pre-exposure prophylaxis (PrEP) among young people in Uganda who had been impacted by HIV. Although PrEP is highly effective for preventing HIV acquisition, uptake among young people remains limited in many settings. Understanding factors that influence PrEP willingness can help inform strategies to improve access to and use of HIV prevention services.
The researchers analyzed cross-sectional data from 905 young people aged 18–21 years who had been orphaned due to AIDS and were participating in the Bridges longitudinal study in southwestern Uganda. Participants were asked about their willingness to use PrEP under a hypothetical scenario in which PrEP was safe, effective, free, and used by relatively few people. The study examined sociodemographic characteristics, perceived HIV risk, perceived PrEP stigma, barriers to PrEP use, and social support. Multilevel mixed-effects logistic regression was used to identify factors independently associated with willingness to use PrEP.
Overall, 74.7% of participants reported that they would be willing to use PrEP under the conditions presented. Older age was significantly associated with greater willingness to use PrEP; each additional year of age corresponded to approximately 10% higher odds of willingness (adjusted odds ratio [aOR] 1.10; 95% CI, 1.01–1.21). Participants who perceived themselves to be at risk for HIV also had significantly higher odds of willingness to use PrEP (aOR 1.65; 95% CI, 1.26–2.17). In contrast, perceived stigma surrounding PrEP was strongly associated with reduced willingness (aOR 0.30; 95% CI, 0.21–0.42). Other factors, including gender, marital status, social support, distance to a clinic, concerns about PrEP, and prior participation in an intervention, were not significant predictors after adjustment.
The findings suggest that willingness to use PrEP is relatively high among young people impacted by HIV, but perceptions of HIV risk and PrEP-related stigma may substantially influence prevention decisions. The authors emphasize the importance of addressing PrEP stigma and strengthening HIV risk communication as part of youth-focused prevention programs. Increasing awareness of PrEP and normalizing its use may help translate willingness into actual uptake and sustained use among young people in Uganda.