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We explored PrEP decision-making through qualitative interviews with 68 adolescent girls and young women (AGYW) aged 15\u201324 years from communities in which a large-scale combination prevention intervention supporting daily oral PrEP uptake for AGYW in South Africa was implemented. Thematic analysis of transcripts was informed by a social-ecological framework. AGYW\u2019s decisions to initiate, continue, discontinue, or refuse PrEP were shaped by intersecting individual, interpersonal, health system, and contextual factors. At the individual level, self-motivation for HIV protection and distrust of partners supported initiation and continuation, reinforced by regular HIV-negative results, while side effects, dislike of daily pills, and perceived contraindications drove discontinuation. Decisions to refuse PrEP centred around low perceived HIV risk, fear of side effects, and aversion to daily tablets, although many expressed conditional interest in future long-acting formulations. Interpersonally, disclosure to and encouragement from family, partners, or friends enabled continuation, whereas inability to disclose, limited social support, and relationship changes undermined adherence. At the health system level, provider engagement, support, and perceived confidentiality of services and packaging were pivotal. Contextually, PrEP-related stigma constrained use, while living in high HIV-prevalence, unsafe communities heightened risk perception and encouraged uptake. PrEP use among AGYW is dynamic and temporal, shaped by relationships, communication and disclosure, embodied experiences, stigma, and service experiences. There is a need for tailored, responsive prevention counselling and service delivery to support AGYW\u2019s PrEP initiation, persistence, and informed decisions about sexual health.<\/jats:p>","DOI":"10.1007\/s10461-025-04994-3","type":"journal-article","created":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T06:49:32Z","timestamp":1766299772000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["\u201cI Just Stopped Taking PrEP Without a Reason\u201d: Understanding PrEP Decision-Making Amongst South African Adolescent Girls and Young Women (AGYW)"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-8152","authenticated-orcid":false,"given":"Zoe","family":"Duby","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Bergh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Jonas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Lotvonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Mathews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,21]]},"reference":[{"key":"4994_CR1","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1007\/s10461-024-04596-5","volume":"29","author":"CE Martin","year":"2025","unstructured":"Martin CE, Muhwava LS, Dada S, et al. Experiences with oral pre-exposure prophylaxis (PrEP) service delivery and use among adolescent girls and young women (AGYW) in routine primary care settings, South Africa. AIDS Behav. 2025;29:1216\u201327. https:\/\/doi.org\/10.1007\/s10461-024-04596-5.","journal-title":"AIDS Behav"},{"key":"4994_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-025-04656-4","author":"J Chen-Charles","year":"2025","unstructured":"Chen-Charles J, Joseph Davey D, Toska E, et al. PrEP uptake and utilisation among adolescent girls and young women in sub-Saharan Africa: a scoping review. AIDS Behav. 2025. https:\/\/doi.org\/10.1007\/s10461-025-04656-4.","journal-title":"AIDS Behav"},{"key":"4994_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26175","volume":"26","author":"L de Vos","year":"2023","unstructured":"de Vos L, Mudzingwa EK, Fynn L, Atujuna M, Mugore M, Gandhi M, et al. Factors that influence adolescent girls and young women\u2019s re-initiation or complete discontinuation from daily oral PrEP use: a qualitative study from Eastern Cape Province, South Africa. J Int AIDS Soc. 2023;26:e26175. https:\/\/doi.org\/10.1002\/jia2.26175.","journal-title":"J Int AIDS Soc"},{"key":"4994_CR4","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s10461-024-04536-3","volume":"29","author":"MW Gichane","year":"2025","unstructured":"Gichane MW, Velloza J, Hosek S, et al. Hoping to adhere? Examining the relationship between hope and pre-exposure prophylaxis willingness, adherence, and persistence among young women in South Africa and Zimbabwe (HPTN 082). 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(PMID: 39325776; PMCID: PMC11426525).","journal-title":"PLoS One"}],"container-title":["AIDS and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-025-04994-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-025-04994-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-025-04994-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T06:49:34Z","timestamp":1766299774000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10461-025-04994-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,21]]},"references-count":42,"alternative-id":["4994"],"URL":"https:\/\/doi.org\/10.1007\/s10461-025-04994-3","relation":{},"ISSN":["1090-7165","1573-3254"],"issn-type":[{"value":"1090-7165","type":"print"},{"value":"1573-3254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,21]]},"assertion":[{"value":"4 December 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing interests to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}},{"value":"Ethical approval for the study was granted by the Human Ethics Research Committee at the South African Medical Research Council (EC027-8\/2023). All participants provided informed consent. For participants under 18 years of age, parental\/guardian consent was obtained. Participants received R200 (approximately US $11) reimbursement for their participation. Referral systems were in place for any participants requiring mental health support or social protection.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent To Participate"}},{"value":"All participants provided consent for the data collected in the study to be anonymised and published.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}}]}}