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To guide future research, measurement and interventions, we developed a conceptual framework for PrEP stigma among adolescent girls and young women (AGYW) in sub\u2010Saharan Africa, a priority population for PrEP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature review, expert consultations and focus group discussions (FGDs) were conducted to adapt the Health Stigma and Discrimination Framework, describing the stigmatization process nested within the socio\u2010ecological framework. We reviewed all articles on PrEP stigma and on HIV, contraceptive or sexuality stigma among AGYW from 2009 to 2019. Expert consultations were conducted with 10 stigma or PrEP researchers and two Kenyan youth advisory boards to revise the framework. Finally, FGDs were conducted with AGYW PrEP users (4 FGDs; <jats:italic>n<\/jats:italic> = 20) and key influencers (14 FGDs; <jats:italic>n<\/jats:italic> = 72) in Kenya with the help of a Youth Research Team who aided in FGD conduct and results interpretation. Results from each phase were reviewed and the framework was updated to incorporate new and divergent findings. This was validated against an updated literature search from 2020 to 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The conceptual framework identifies potential drivers, facilitators and manifestations of PrEP stigma, its outcomes and health impacts, and relevant intersecting stigmas. The main findings include: (1) PrEP stigma is driven by HIV, gender and sexuality stigmas, and low PrEP community awareness. (2) Stigma is facilitated by factors at multiple levels: policy (e.g. targeting of PrEP to high\u2010risk populations), health systems (e.g. youth\u2010friendly service availability), community (e.g. social capital) and individual (e.g. empowerment). (3) Similar to other stigmas, manifestations include labelling, violence and shame. (4) PrEP stigma results in decreased access to and acceptability of PrEP, limited social support and community resistance, which can impact mental health and decrease PrEP uptake and adherence. (5) Stigma may engender resilience by motivating AGYW to think of PrEP as an exercise in personal agency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our PrEP stigma conceptual framework highlights potential intervention targets at multiple levels in the stigmatization process. Its adoption would enable researchers to develop standardized measures and compare stigma across timepoints and populations as well as design and evaluate interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26213","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T04:37:09Z","timestamp":1708490229000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["The development of a conceptual framework on PrEP stigma among adolescent girls and young women in sub\u2010Saharan Africa"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8109-9679","authenticated-orcid":false,"given":"Miriam","family":"Hartmann","sequence":"first","affiliation":[{"name":"Women's Global Health Imperative RTI International  Berkeley California USA"},{"name":"Department of Global Public Health Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8067-4192","authenticated-orcid":false,"given":"Laura","family":"Nyblade","sequence":"additional","affiliation":[{"name":"Women's Global Health Imperative RTI International  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Otticha","sequence":"additional","affiliation":[{"name":"Impact Research Development Organization  Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tozoe","family":"Marton","sequence":"additional","affiliation":[{"name":"Women's Global Health Imperative RTI International  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6153-8950","authenticated-orcid":false,"given":"Kawango","family":"Agot","sequence":"additional","affiliation":[{"name":"Impact Research Development Organization  Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3318-9781","authenticated-orcid":false,"given":"Sarah T.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Women's Global Health Imperative RTI International  Berkeley California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Communities at the centre: defending rights, breaking barriers, reaching people with HIV services","author":"UNAIDS","year":"2019"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30433-3"},{"key":"e_1_2_12_4_1","unstructured":"Rousseau\u2010JemwaE BekkerL\u2010G BukusiE Delaney\u2010MoretlweS OmolloV TravillD et\u00a0al.Early persistence of HIV pre\u2010exposure prophylaxis (PrEP) in African adolescent girls and young women (AGYW) from Kenya and South Africa.HIV Research for Prevention Conference; 21\u201325 October 2018;Madrid Spain."},{"issue":"6","key":"e_1_2_12_5_1","article-title":"How long will they take it? 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