By: Bunmi Yekini
A new study conducted across three African countries has shed light on how adolescent girls and young women (AGYW) navigate complex choices between HIV prevention methods. The study, part of the REACH trial, explored how young women decide between two pre-exposure prophylaxis (PrEP) options the oral pill and the dapivirine vaginal ring.
The trial, which took place in South Africa, Zimbabwe, and Uganda, offered 247 young women, aged 16 to 21, the chance to use both products for six months each. Participants then had the option to choose between continuing with either product—or neither—for another six months. Through focus group discussions and in-depth interviews, researchers sought to understand what factors influenced their choices.
For many young women, the decision came down to personal experience with the products and their ability to fit HIV prevention into their daily lives. The desire to remain HIV-negative was a strong motivating factor, but product attributes such as comfort, ease of use, and side effects were critical in shaping decisions.
“I liked the pill because I could take it privately without anyone knowing, but the ring made me feel more protected,” said one participant from Zimbabwe. “I had to weigh what worked best for me.”
Many of the young women found that the opportunity to try both the pill and the ring helped them make more informed choices. For some, switching between products allowed them to manage side effects better, while others valued the discretion that the pill offered in environments where HIV stigma is still prevalent.
“AGYW are not just looking for what works medically, but what fits into their lives,”noted the study authors. “Product triability is crucial. Allowing young women to experience these prevention tools firsthand empowers them to make decisions that feel right for their personal circumstances.”
For participants like 19-year-old Thandiwe from South Africa, the decision to stick with oral PrEP was driven by how easily it fit into her daily routine, despite concerns about potential side effects. “The ring was okay, but I didn’t want to feel it all the time. I knew I could take the pill without it affecting me as much,” she shared.
The study highlighted how hands-on experience and guidance from trusted healthcare providers play a significant role in helping AGYW navigate these life-changing decisions. With the growing availability of biomedical prevention methods like the vaginal ring and oral PrEP, the research emphasizes that supporting young women through this decision-making process will be critical to improving uptake and long-term adherence.
Dr. Nontobeko Mokoena, a researcher involved in the study, remarked, “These findings underline the importance of trust and support in healthcare. Young women want to feel empowered to make their own choices, but they also need reassurance from providers they trust. This relationship will be vital as more HIV prevention options become available.”
As HIV prevention methods evolve, studies like REACH offer vital insights into how real-world implementation can be adapted to meet the needs of young women most at risk.
This research marks an important step toward more effective prevention strategies, ultimately aiming to empower young women to protect themselves against HIV in ways that suit their lifestyles, while addressing the social challenges they face.