Relationship dynamics and anticipated stigma: Key considerations for PrEP use among Tanzanian adolescent girls and young women and male partners

Objectives: We examined key interpersonal and community dynamics influencing PrEP acceptability among adolescent girls and young women (AGYW) and their male partners. Methods: We administered 12 in-depth interviews (IDI) to HIV-negative, partnered or married AGYW aged 15–24 years, and 16 IDIs to men aged 18 or older, partnered or married to an AGYW in Tanzania. Card sorting was used to identify attitudes, values, and desires that would influence PrEP acceptability. Results: Relationship distrust, partner communication, and need to control HIV risk were highly influential considerations for PrEP use. Men and women both wanted to discuss PrEP use amidst relationship distrust, while most men encouraged AGYW PrEP use for shared protective benefit. Anticipated stigma of being perceived as HIV-positive associated with PrEP use was a deterrent for men and women while AGYW also feared stigma of being considered sexually promiscuous. Conclusions: Couples counseling for PrEP uptake and adherence might be a well-placed strategy for couples who are HIV negative to educate one another about the relationship benefits of using PrEP, thereby increasing its acceptance and adherence, and reducing associated distrust. Community awareness and education about PrEP can help curb persistent PrEP stigma.