Secrecy, empowerment and protection: positioning PrEP in KwaZulu-Natal, South Africa

Cult Health Sex. 2017 Nov;19(11):1268-1285. doi: 10.1080/13691058.2017.1309682. Epub 2017 Apr 20.


The release of World Health Organisation guidelines recommending the prophylactic use of daily Truvada® for all populations at high risk of acquiring HIV opens the way for implementation of oral pre-exposure prophylaxis (PrEP). The impact of new prevention technologies is, however, dependent on demand creation strategies such as user awareness, acceptability and access, which in turn are influenced by sociocultural and gender norms. This study was conducted in three locations in KwaZulu-Natal, urban, rural and peri-urban, with six participatory workshops. Knowledge, desirable features of a product and demand positioning for PrEP were assessed using a participatory action media research process which included art-based activities and group discussion using a semi-structured interview schedule. The data were analysed using thematic analysis. The key themes that emerged in relation to product adoption were: ability to maintain secrecy of product use; the need for agency with personal choices around HIV prevention; and an increased desire for HIV protection. Findings reaffirm the influence of user engagement in understanding the sociocultural dynamics that influence demand creation for PrEP adoption.

Keywords: HIV prevention; Pre-exposure prophylaxis; South Africa; action media; demand creation; women.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Confidentiality*
  • Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination / therapeutic use
  • Female
  • HIV Infections / prevention & control*
  • Humans
  • Middle Aged
  • Power, Psychological*
  • Pre-Exposure Prophylaxis*
  • Safe Sex
  • South Africa
  • Young Adult


  • Anti-HIV Agents
  • Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination