International Mentored Scientist Award

HIV incidence remains notably high in South Africa despite the country having the largest HIV care program globally. The HIV prevention interventions in rural South Africa are failing to effectively reach adolescent boys and young men (ABYM), particularly in Mpumalanga Province, where nearly 1 in 10 ABYM is already living with HIV, 1.5 times the prevalence in women of this age. Despite their elevated risk of HIV exposure, ABYM underutilize available prevention services, with one third reporting never tested for HIV or have not tested in the last three years. Awareness and uptake daily oral preexposure prophylaxis (PrEP) remain low despite its proven effectiveness. Barriers to access include systemic challenges, and individual factors, including societal norms that discourage engagement with health services. Innovative approaches are needed to connect young men to prevention services beyond traditional health facilities. Trusted adults, including non-parental figures may play a significant role in shaping young men's attitudes and behaviors toward sexual health. Research from other settings suggests that non-judgmental communication with trusted adults can promote positive sexual health outcomes. However, little is known about how these dynamics play out in rural South Africa. This sequential explanatory mixed-methods study aims to explore the role of trusted adult relationships and communication in shaping HIV prevention decisions and behaviors, including PrEP uptake, among ABYM aged 18 to 24.We begin by characterizing the prevalence of trusted adults among 100-150 ABYM aged 18-24 years and evaluate the extent of conversations about sexuality and HIV prevention with these individuals, drawing from a larger population based survey project with 300 ABYW aged 18-34 years. Subsequently, conducting in-depth interviews (IDIs) with 12 ABYM and 12 trusted adults to understand the dynamics of their relationships and how they influence communication about sensitive topics such as HIV prevention, including PrEP, in South Africa. The findings will enrich my PhD dissertation, supporting future postdoctoral research and ultimately inform future studies on communication initiatives designed to harness ABYM’s relationships with trusted adults to improve discussions about and access to sexual health and related services. The study will be supported by mentors with established research in this area.