Mwima Simon, Bogart Laura M, Neema Steela, Komo Richard, Obbo Stephen
Department of Social Work, University of Illinois Urbana Champagne, Champaign, IL, United States.
Bukedi Prevention Institute, Mbale, Uganda.
Front Glob Womens Health. 2025 Mar 20;6:1517448. doi: 10.3389/fgwh.2025.1517448. eCollection 2025.
The disclosure of oral pre-exposure prophylaxis (PrEP) use among adolescent girls engaged in transactional sex in Uganda is a complex process shaped by stigma, fear of judgment, misconceptions, and the threat of violence. This qualitative study explores the strategies these adolescents use to navigate these challenges, drawing on resilience theory and asset-based approaches.
Between April 2018 and May 2019, cross-sectional semi-structured interviews were conducted with Ugandan adolescent girls aged 18-24 engaged in transactional sex to explore their experiences of PrEP disclosure. Data were analyzed using a thematic network analysis approach, focusing on how participants managed the social and psychological barriers to disclosure.
The study found that stigma, misconceptions about PrEP, and fear of judgment or violence from clients and families were significant barriers to disclosure. However, adolescent girls employed multiple strategies to navigate these challenges. These included relying on peer support, selective disclosure to trusted individuals, and drawing on personal strength and resilience. Support from healthcare providers and access to youth-friendly health services further helped participants manage the risks associated with PrEP disclosure. Many participants used a combination of these strategies, adapting their approach to different social contexts.
This study highlights the complex strategies adolescent girls engaged in transactional sex in Uganda use to disclose PrEP use amidst significant barriers. The findings emphasize the need for targeted interventions that focus on strengthening peer support, enhancing the role of healthcare providers, and creating safe spaces for disclosure. By integrating these strategies into PrEP delivery models, public health efforts can empower these vulnerable populations to disclose and adhere to PrEP more confidently, improving HIV prevention outcomes.
在乌干达，从事性交易的少女中披露口服暴露前预防（PrEP）的使用情况是一个复杂的过程，受到耻辱感、对评判的恐惧、误解以及暴力威胁的影响。这项定性研究借鉴复原力理论和基于资产的方法，探讨这些青少年用于应对这些挑战的策略。
在2018年4月至2019年5月期间，对年龄在18 - 24岁、从事性交易的乌干达少女进行了横断面半结构化访谈，以探讨她们披露PrEP使用情况的经历。使用主题网络分析方法对数据进行分析，重点关注参与者如何应对披露的社会和心理障碍。
研究发现，耻辱感、对PrEP的误解以及对来自客户和家庭的评判或暴力的恐惧是披露的重大障碍。然而，少女们采用了多种策略来应对这些挑战。这些策略包括依靠同伴支持、有选择地向信任的人披露，以及利用个人力量和复原力。医疗保健提供者的支持和获得对青少年友好的健康服务进一步帮助参与者管理与PrEP披露相关的风险。许多参与者结合使用这些策略，根据不同的社会背景调整方法。
本研究强调了乌干达从事性交易的少女在存在重大障碍的情况下披露PrEP使用情况所采用的复杂策略。研究结果强调了有针对性干预措施的必要性，这些措施应侧重于加强同伴支持、增强医疗保健提供者的作用以及为披露创造安全空间。通过将这些策略纳入PrEP提供模式，公共卫生工作可以使这些弱势群体更自信地披露和坚持PrEP，改善艾滋病毒预防成果。
