Submission ID 130318
| Issue/Objective | Participants described significant barriers to PrEP disclosure, including stigma, fear of violence, and social exclusion from family, clients, and communities. Despite these challenges, adolescents demonstrated resilience through multiple protective mechanisms. Key facilitators included peer and provider support, access to youth-friendly and non-judgmental health services, and individual coping strategies such as selective disclosure and leveraging knowledge of PrEP benefits. These factors enabled participants to navigate disclosure decisions while minimizing social and personal risks. |
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| Methodology/Approach | Between April 2024 and May 2025, we conducted a qualitative study using semi-structured interviews with adolescent girls aged 15-24 years engaged in transactional sex in Uganda. Participants were purposively recruited from the Most At-Risk Populations Initiative (MARPI) clinic in Kampala, a key national HIV prevention and care program serving key and priority populations. Interviews explored experiences of PrEP use and disclosure within high-stigma social environments. Data were analyzed using a directed content analysis approach guided by resilience theory. |
| Results | Participants described significant barriers to PrEP disclosure, including stigma, fear of violence, and social exclusion from family, clients, and communities. Despite these challenges, adolescents demonstrated resilience through multiple protective mechanisms. Key facilitators included peer and provider support, access to youth-friendly and non-judgmental health services, and individual coping strategies such as selective disclosure and leveraging knowledge of PrEP benefits. These factors enabled participants to navigate disclosure decisions while minimizing social and personal risks. |
| Discussion/Conclusion | This study highlights the interplay of social, psychological, and structural determinants shaping PrEP disclosure among adolescent girls engaged in transactional sex. Findings underscore the need for equity-driven, youth-centered interventions that strengthen supportive service environments and address stigma at multiple levels. Integrating resilience-informed approaches within PrEP delivery can enhance safe disclosure and improve prevention outcomes. These findings contribute to advancing global health equity by centering marginalized voices and informing context-responsive HIV prevention strategies in high-stigma settings. |
| Presenters and Affiliations | Simon Mwima University of Illinois Urbana Champaign Stephen Walwo Mbale Regional Referal Hospital Leah Namono Uganda Red Cross Society Winnie Namukambi Uganda Christian University |
