Pharmacy-Based Pre-Exposure Prophylaxis (PrEP) - A qualitative Study About PrEP Awareness, Knowledge, and Perceptions in South Africa - Johannesburg, Pretoria and Cape Town

Abstract

Background: South Africa continues to face a high incidence of HIV despite the availability of effective prevention methods such as pre-exposure prophylaxis (PrEP). Although national guidelines support the use of PrEP since 2016, uptake remains limited, largely due to persistent misconceptions, stigma, and low perceived risk of HIV. Aim: This thesis explores how individual, interpersonal, community, and structural factors influence awareness, knowledge, and perceptions of PrEP in South Africa within a pharmacy-led PrEP delivery model. Methods: A qualitative secondary analysis was conducted on 121 in-depth interviews from the PPrEPP-SA implementation study, including clients and healthcare workers across Johannesburg, Pretoria, and Cape Town. The thematic analysis was guided by the Socio-Ecological Model (SEM), enabling examination across the four levels of influence. Results: Participants exhibited varying levels of PrEP knowledge, often confusing it with HIV treatment or post-exposure prophylaxis (PEP). While many valued PrEP as empowering and protective, low perceived risk, stigma, and misinformation often hindered uptake. Interpersonal relationships served as both enablers and barriers; support from peers and partners enhanced engagement, while judgment and misinformation discouraged use. At the community level, PrEP was often associated with promiscuity or HIV-positive status, reinforcing stigma. Structural facilitators included pharmacy-based services, which were perceived as more accessible, confidential, and respectful than clinics. Healthcare provider engagement emerged as an important factor in correcting misconceptions and motivating use. Conclusion: PrEP uptake is shaped by dynamic interactions across SEM levels. Addressing individual-level gaps in knowledge requires community-level destigmatization, interpersonal support, and structurally accessible, trusted delivery models. Pharmacy-based PrEP delivery shows promise for increasing access but must be embedded within multi-level strategies to combat stigma and normalize use. Findings offer practical insights for public health policy and intervention design in high HIV-burden contexts. Future research should explore how pharmacy-based PrEP delivery can enhance knowledge sharing and assess its effectiveness in rural contexts.