"Taking PrEP every day for me is a challenge" : Barriers, and facilitators to accessing HIV pre-exposure prophylaxis (PrEP) services among young people in Gauteng, South Africa

BackgroundPre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, yet uptake remains suboptimal and ensuring access to PrEP services among young people is critical. We explored the barriers and facilitators associated with accessing PrEP among young people MethodsFocus group discussions (FGDs) were conducted in April and May 2023 in the City of Johannesburg district in South Africa. Participants were adult males and females (ages 18-35) self-reporting as HIV negative with or without previous PrEP use and exposure. We analysed transcripts using a deductive and inductive thematic approach. Two transcripts were coded by three coders to test reliability and saturation was reached when no new themes emerged. ResultsFindings were mapped to the Socio-Ecological Model (SEM). Key barriers emerged across levels. Individual level barriers included difficulty adhering to daily oral PrEP and fear of needles. Interpersonal challenges included anxiety about disclosing PrEP use to partners or family. Institutional and organisational barriers involved long clinic queues, negative staff attitudes, limited confidentiality and inadequate PrEP information. At the community level, stigma and misconceptions linking PrEP to HIV treatment deterred uptake. Several facilitators emerged. Individual motivation to remain HIV negative was a strong driver of uptake. Supportive relationships and open communication with friends and family enhanced acceptance. Organisational enablers included access to clear information, youth-friendly services, competent providers and delivery options such as home delivery or pharmacy access. Community awareness initiatives reduced stigma and structural support in a form of free PrEP improved affordability and access. ConclusionYoung peoples access to PrEP is shaped by interactions across individual, relational, institutional, community, and structural levels. Tailored interventions that address personal barriers, strengthen supportive environments, improve service delivery, and ensure affordability are likely to strengthen uptake and adherence. These findings highlight the need for multilevel strategies to optimize PrEP implementation among youth.