“We mostly focus on preventing pregnancy, we don’t really focus on preventing HIV …”: Young people’s perceptions and priorities when preventing unplanned pregnancy and HIV

Abstract

In South Africa, the high rate of human immunodeficiency virus (HIV) infection among young people and unplanned pregnancies  remains a concern. Using a qualitative approach, this study aimed to explore how young people between 18 and 24 years old perceive the  risk of unplanned pregnancy and HIV, and how they give priority to and act to prevent both concerns. Fifty-four young people were  recruited from three provinces in South Africa: KwaZulu-Natal, Eastern Cape, and Gauteng. Data collection took place between May and  June in 2016. All data collection was carried out in person using a standardised discussion guide and a semi-structured interview guide in English. We conducted eight focus group discussions with young people and three in-depth interviews with young people who had  become parents in their teens. We utilised thematic analysis grounded in a social constructionist framework to assess patterns and  associations in the data. Respondents reported unplanned pregnancy and HIV as prevalent among their peers, but prioritised both  concerns differently. Preventing pregnancy was a greater priority and threat than HIV. Respondents were less concerned about being  infected with HIV which was perceived as invisible and not a death sentence because of the efficacy and ease of use of treatment. HIV  was considered comparatively more manageable and less burdensome than other chronic illnesses and unplanned pregnancy. Our study  suggests unplanned pregnancy and HIV prevention interventions should prioritise responding to young people’s primary desire to  control their fertility, but also encourage them to have holistic sexual and reproductive health goals that include HIV prevention. Our  findings suggest a pressing need for biomedical therapies that offer combined HIV and pregnancy prevention for young people. Future  programmes need to be agile and innovative in addressing young people’s tendency to prioritise HIV and pregnancy differently, and they  need to revive the sense of urgency to prevent HIV.