Motivations for Starting and Stopping PrEP: Experiences of Adolescent Girls and Young Women in the HPTN 082 Trial

Lisa Mills; Makhosazane Nomhle Ndimande-Khoza; Jennifer Velloza; Millicent Atujuna; Miria Chitukuta; Sybil Hosek; Hlukelo Chauke; Petina Musara; Nomvuyo Mangxilana; Prisca Mutero; Lerato Michelle Makhale; Thelma Tauya; Connie Celum; Sinead Delany-Moretlwe; HPTN 082 study team

doi:10.1007/s10461-025-04703-0

Motivations for Starting and Stopping PrEP: Experiences of Adolescent Girls and Young Women in the HPTN 082 Trial

AIDS Behav. 2025 Jun 3. doi: 10.1007/s10461-025-04703-0. Online ahead of print.

Authors

Affiliations

¹ Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Johannesburg, 2000, Republic of South Africa. lmills@wrhi.ac.za.
² Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, 22 Esselen Street, Johannesburg, 2000, Republic of South Africa.
³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
⁴ Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Scienced, University of Cape Town, Cape Town, South Africa.
⁵ University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe.
⁶ Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois College of Medicine, Chicago, IL, USA.
⁷ Departments of Global Health, Medicine, Epidemiology, University of Washington, Seattle, WA, USA.

PMID: 40457089
DOI: 10.1007/s10461-025-04703-0

Abstract

Oral PrEP effectiveness depends on consistent use during periods of potential HIV exposure, but adolescent girls and young women (AGYW) find this challenging. Data on PrEP use decision-making and alignment with risk among AGYW are limited. From 2016 to 2018, we conducted in-depth interviews with participants in HPTN 082, an open-label PrEP study in South Africa and Zimbabwe, to explore reasons for PrEP starts, stops, and restarts. Of 60 PrEP acceptors, 12 delayed acceptance, 15 used PrEP intermittently, 18 paused and restarted PrEP, and 13 permanently discontinued PrEP during 12-month follow-up. Perceived HIV vulnerability motivated PrEP start, but there was little evidence that fluctuating risk perception motivated prevention-effective use. PrEP stops were motivated by stigma, misconceptions and side effects; PrEP restarts were prompted by support from family, peers and clinic staff. Decision-making was related to social, gendered and normative influences, highlighting opportunities for psycho-educational support and multimedia campaigns to normalise HIV prevention.

Keywords: Adherence; Africa; HIV; Pre-exposure Prophylaxis; Social Factors; Women.