{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:05Z","timestamp":1787027285536,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Imagine programme is a school-based HIV prevention program offering preexposure prophylaxis (PrEP), condoms and other social and structural interventions to adolescent girls and young women (AGYW) in South Africa. PrEP uptake and adherence together with the provision of condoms has not been extensively studied in the school context. We explored the barriers to and facilitators of PrEP and condom usage among Imagine programme beneficiaries using the HIV prevention cascade framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixteen AGYW aged 16\u201320 years who had never taken PrEP, were on PrEP or had stopped PrEP were interviewed between November 2023 and March 2024. Interviews were audio-recorded, and transcripts were deductively coded according to the HIV prevention cascade steps: (1) Knowledge, (2) Motivation, (3) Access and (4) Effective use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HIV and pregnancy risk awareness was high. For condom use, the risk of HIV transmission and pregnancy was outweighed by fear of sexual or physical violence from male partners and a desire to maintain relationships, as asking to use condoms demonstrated a lack of trust. High levels of PrEP knowledge motivated participants to use PrEP, especially if their partner refused to use condoms. Fear of side effects and daily pill taking were barriers to PrEP uptake. PrEP and condom services in school were highly acceptable, while anticipated stigma remained a challenge at the community clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Barriers to condom use persist in South Africa, but positive attitudes toward PrEP described in this study suggest that opinions about PrEP are still forming and can be strongly influenced by youth-friendly HIV programming in schools.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1616261","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T06:20:05Z","timestamp":1763619605000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["\u201cI will take PrEP because that\u2019s what will help me not to get infected with HIV\u201d: barriers to and facilitators of pre-exposure prophylaxis and condom use among adolescent girls and young women enrolled in a school-based HIV prevention program in South Africa"],"prefix":"10.3389","volume":"13","author":[{"given":"Kate","family":"Bergh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Jonas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elona","family":"Toska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fareed","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomtopi","family":"Blom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Mathews","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngkatiseng","family":"Mthanti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nevilene","family":"Slingers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanael","family":"van Blydenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Duby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"ref1","author":"Shisana","year":"2022"},{"key":"ref2","author":"Simbayi","year":"2017"},{"key":"ref3","year":"2023"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1371\/journal.pone.0002077","article-title":"The impact of pre-exposure prophylaxis (PrEP) on HIV epidemics in Africa and India: a simulation study","volume":"3","author":"Vissers","year":"2008","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4102\/SAJHIVMED.V21I1.1152","article-title":"Southern African guidelines on the safe, easy and effective use of pre-exposure prophylaxis: 2020","volume":"21","author":"Bekker","year":"2020","journal-title":"South Afr J HIV Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"558","DOI":"10.3389\/frph.2022.1086558","article-title":"Introduction and integration of PrEP and sexual and reproductive health services for young people: health provider perspectives from South Africa","volume":"4","author":"Pleaner","year":"2022","journal-title":"Front Reprod Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1007\/s10508-020-01880-y","article-title":"Exploring perceived barriers and facilitators of PrEP uptake among young people in Uganda, Zimbabwe, and South Africa","volume":"50","author":"Muhumuza","year":"2021","journal-title":"Arch Sex Behav"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1080\/16549716.2021.1886455","article-title":"Pre-exposure prophylaxis (PrEP) awareness, attitudes and uptake willingness among young people: gender differences and associated factors in two south African districts","volume":"14","author":"Shamu","year":"2021","journal-title":"Glob Health Action"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1136\/bmjopen-2022-061503","article-title":"Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review","volume":"13","author":"Ramraj","year":"2023","journal-title":"BMJ Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2588","DOI":"10.1007\/s10461-025-04719-6","article-title":"Assessing PrEP initiation and adherence among high-risk, sexually active adolescents and young adults: a population-based prospective study across diverse service delivery models in a high HIV prevalent district in South Africa","volume":"29","author":"Nicol","year":"2025","journal-title":"AIDS Behav"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0258542","DOI":"10.1371\/journal.pone.0258542","article-title":"Adolescent girls and young women\u2019s PrEP-user journey during an implementation science study in South Africa and Kenya","volume":"16","author":"Rousseau","year":"2021","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e51998","DOI":"10.1371\/journal.pone.0051998","article-title":"Predictors of inconsistent condom use among a hard to reach population of young women with multiple sexual Partners in Peri-Urban South Africa","volume":"7","author":"Zembe","year":"2012","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1007\/s10461-023-04130-z","article-title":"Applying the HIV prevention Cascade to an evaluation of a large-scale combination HIV prevention programme for adolescent girls and young women in South Africa","volume":"28","author":"Bergh","year":"2024","journal-title":"AIDS Behav"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1080\/19317611.2020.1851334","article-title":"\u201cCondoms are boring\u201d: navigating relationship dynamics, gendered power, and motivations for condomless sex amongst adolescents and young people in South Africa","volume":"33","author":"Duby","year":"2021","journal-title":"Int J Sex Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1186\/s12889-021-11306-6","article-title":"Adolescent condom use in southern Africa: narrative systematic review and conceptual model of multilevel barriers and facilitators","volume":"21","author":"Aventin","year":"2021","journal-title":"BMC Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1007\/s10508-015-0525-1","article-title":"Sociocognitive predictors of condom use and intentions among adolescents in three sub-Saharan sites","volume":"45","author":"Eggers","year":"2016","journal-title":"Arch Sex Behav"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1379","DOI":"10.1080\/09540121003758465","article-title":"Factors associated with consistent condom use among rural young women in South Africa","volume":"22","author":"Jama Shai","year":"2010","journal-title":"AIDS Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e25498","DOI":"10.1002\/jia2.25498","article-title":"A tale of two cascades: promoting a standardized tool for monitoring progress in HIV prevention","volume":"23","author":"Auerbach","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e60","DOI":"10.1016\/S2352-3018(18)30327-8","article-title":"HIV prevention cascades: a unifying framework to replicate the successes of treatment cascades","volume":"6","author":"Schaefer","year":"2019","journal-title":"Lancet HIV"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e297","DOI":"10.1016\/S2352-3018(16)30039-X","article-title":"Providing a conceptual framework for HIV prevention cascades and assessing feasibility of empirical measurement with data from East Zimbabwe: a case study","volume":"3","author":"Garnett","year":"2016","journal-title":"Lancet HIV"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1007\/s10461-019-02407-w","article-title":"Application of an HIV prevention Cascade to identify gaps in increasing coverage of voluntary medical male circumcision services in 42 rural Zambian communities","volume":"23","author":"Hensen","year":"2019","journal-title":"AIDS Behav"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/QAI.0000000000001980","article-title":"How can programs better support female sex workers to avoid HIV infection in Zimbabwe? A prevention cascade analysis","volume":"81","author":"Fearon","year":"2020","journal-title":"Epidemiology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e25309","DOI":"10.1002\/jia2.25309","article-title":"Application of the HIV prevention cascade to identify, develop and evaluate interventions to improve use of prevention methods: examples from a study in East Zimbabwe","volume":"22","author":"Moorhouse","year":"2019","journal-title":"J Int AIDS Soc"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-018-5842-6","article-title":"Using a cascade approach to assess condom uptake in female sex workers in India: a review of the Avahan data","volume":"18","author":"Weiner","year":"2018","journal-title":"BMC Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e25537","DOI":"10.1002\/jia2.25537","article-title":"Using a HIV prevention cascade for identifying missed opportunities in PrEP delivery in Kenya: results from a programmatic surveillance study","volume":"23","author":"Were","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e25512","DOI":"10.1002\/jia2.25512","article-title":"Condom use among young women who sell sex in Zimbabwe: a prevention cascade analysis to identify gaps in HIV prevention programming","volume":"23","author":"Chabata","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1097\/QAI.0000000000002733","article-title":"How can we support the use of oral PrEP among young women who sell sex? A PrEP cascade analysis","volume":"88","author":"Hensen","year":"2021","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e1105","DOI":"10.5281\/zenodo.7258438","article-title":"Strengthening the HIV prevention cascade to maximise epidemiological impact in eastern Zimbabwe: a modelling study","volume":"11","author":"Pickles","year":"2023","journal-title":"Lancet"},{"key":"ref29","year":"2016"},{"key":"ref30","year":"2020"},{"key":"ref31","year":"2020"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2954","DOI":"10.1111\/jan.13031","article-title":"Systematic methodological review: developing a framework for a qualitative semi-structured interview guide","volume":"72","author":"Kallio","year":"2016","journal-title":"J Adv Nurs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1471-2288-14-21","article-title":"Using vignettes in qualitative research to explore barriers and facilitating factors to the uptake of prevention of mother-to-child transmission services in rural Tanzania: a critical analysis","volume":"14","author":"Gourlay","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/1471-2288-13-117","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"ref35","year":"2023"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"197","DOI":"10.2307\/25549740","article-title":"Knowledge of correct condom use and consistency of use among adolescents in four countries in sub-Saharan Africa","volume":"11","author":"Bankole","year":"2007","journal-title":"Afr J Reprod Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1071\/SH11095","article-title":"Condom use errors and problems: a global view","volume":"9","author":"Sanders","year":"2012","journal-title":"Sex Health"},{"key":"ref38","year":"2024"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1007\/s10461-022-03750-1","article-title":"\u201cThese girls have a chance to be the future generation of HIV negative\u201d: experiences of implementing a PrEP programme for adolescent girls and young women in South Africa","volume":"27","author":"Duby","year":"2023","journal-title":"AIDS Behav"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1080\/15381501.2024.2368909","article-title":"Challenges to PrEP use in adolescent girls young women in sub-Saharan Africa: a systematic review of qualitative studies","volume":"22","author":"Alashek","year":"2023","journal-title":"J HIV AIDS Soc Serv"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"702","DOI":"10.3389\/frph.2022.1048702","article-title":"Improving HIV pre-exposure prophylaxis persistence among adolescent girls and young women: insights from a mixed-methods evaluation of community, hybrid, and facility service delivery models in Namibia","volume":"4","author":"Barnabee","year":"2022","journal-title":"Front Reprod Health"},{"key":"ref42","volume-title":"Policy brief: pre-exposure prophylaxis (PrEP): WHO expands recommendation on oral pre-expo- sure prophylaxis of HIV infection (PrEP)","year":"2015"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1007\/s10461-020-03145-0","article-title":"The PrEP journey: understanding how internal drivers and external circumstances impact the PrEP trajectory of adolescent girls and young women in Cape Town, South Africa","volume":"25","author":"O\u2019Rourke","year":"2021","journal-title":"AIDS Behav"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"3079","DOI":"10.1007\/s10461-022-03652-2","article-title":"Barriers to oral HIV pre-exposure prophylaxis (PrEP) adherence among pregnant and post-partum women from Cape Town, South Africa","volume":"26","author":"Beesham","year":"2022","journal-title":"AIDS Behav"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1186\/s12889-022-13445-w","article-title":"Safe spaces for beneficiaries of a combination HIV prevention intervention for adolescent girls and young women in South Africa: access, feasibility, and acceptability","volume":"22","author":"Mathews","year":"2022","journal-title":"BMC Public Health"},{"key":"ref46","year":"2023"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"2015","DOI":"10.1007\/s10461-022-03935-8","article-title":"\u201cMen rule\u2026 this is the Normal thing. We normalise it and it\u2019s wrong\u201d: gendered power in decision-making around sex and condom use in heterosexual relationships amongst adolescents and young people in South Africa","volume":"27","author":"Duby","year":"2022","journal-title":"AIDS Behav"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e0248307","DOI":"10.1371\/journal.pone.0248307","article-title":"Experiences of oral pre-exposure prophylaxis (PrEP) use disclosure among south African adolescent girls and young women and its perceived impact on adherence","volume":"16","author":"Giovenco","year":"2021","journal-title":"PLoS One"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1080\/09540121.2020.1744507","article-title":"\u201cNow that PrEP is reducing the risk of transmission of HIV, why then do you still insist that we use condoms?\u201d the condom quandary among PrEP users and health care providers in Kenya","volume":"33","author":"Irungu","year":"2021","journal-title":"AIDS Care"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s10461-021-03366-x","article-title":"Delivering PrEP to young women in a low - income setting in South Africa: lessons for providing both convenience and support","volume":"26","author":"Cassidy","year":"2021","journal-title":"AIDS Behav"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1616261\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T13:41:42Z","timestamp":1763991702000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1616261\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,20]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2025.1616261"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1616261","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,20]]},"article-number":"1616261"}}