# Understanding and measuring the impact of stigma on PrEP adherence among adolescent girls and young women in Kenya: identifying targets for future interventions

> **NIH NIH R21** · RESEARCH TRIANGLE INSTITUTE · 2021 · $179,409

## Abstract

PROJECT SUMMARY/ABSTRACT
Adolescent girls and young women (AGYW) in sub-Saharan Africa are highly vulnerable to HIV. In Kenya,
youth ages 15–24 account for 33% of new infections annually, and incidence is twice as high in AGYW as it
is in young men. Pre-exposure prophylaxis (PrEP) is a powerful tool to reduce HIV acquisition, but
adherence has been low among AGYW, limiting its protective benefit. PrEP stigma—typically based on
stereotypes of users as “promiscuous” or HIV-positive—is emerging as a key barrier to adherence. However,
evidence among AGYW is limited. The goal of the proposed study is to improve our understanding of stigma-
related barriers to PrEP adherence among AGYW in Kenya and identify potential intervention approaches
and targets. The study will build on our recent research to adapt the Health Stigma and Discrimination
Framework for PrEP stigma among AGYW and will leverage our successful partnership with Impact
Research and Development Organization (IRDO), which is implementing the DREAMS Initiative in Siaya
County, Kenya and has initiated more than 3,900 AGYW on PrEP. We will build stigma research capacity at
IRDO by mentoring early-career Research Associates and training local AGYW youth researchers. The
specific aims are to (1) develop and validate a scaled instrument to measure relevant dimensions of PrEP
stigma among AGYW who use PrEP, and (2) assess the relationship between stigma and PrEP adherence
and identify intervention targets. Aim 1 will use youth-led participatory research to refine the PrEP stigma
framework with AGYW, identify key components of PrEP stigma, and understand how related types of
stigma (HIV, gender, and sexuality) overlap with PrEP stigma. Findings will inform the development of the
initial scale. After cognitive testing, the scale will be piloted with 200 AGYW to confirm the hypothesized
factor structure and assess reliability and construct validity, including whether it is distinct from other types of
stigma. Aim 2 will use a mixed methods approach. For Aim 2a, we will conduct a quantitative survey with 300
AGYW PrEP users to determine the prevalence of various types and dimensions of stigma impacting AGYW,
measuring PrEP stigma with the Aim 1 scale. Participants will be prospectively followed using DREAMS
program data to test the association of baseline stigma with PrEP adherence (both persistence and
execution) over the next 6 months. For Aim 2b, we will conduct qualitative focus group discussions with
AGYW and their key influencers (family members, peers, partners, and health care providers) to understand
stigmatizing attitudes and behaviors and assess the acceptability of candidate interventions. The qualitative
and quantitative findings will be integrated to identify future intervention targets and approaches. This study’s
focus on PrEP stigma among Kenyan AGYW is innovative and fills a critical gap in efforts to end the HIV
epidemic. The findings will lay the groundwork to develop and test a c...

## Key facts

- **NIH application ID:** 10220170
- **Project number:** 5R21TW011784-02
- **Recipient organization:** RESEARCH TRIANGLE INSTITUTE
- **Principal Investigator:** Sarah Tyler Roberts
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $179,409
- **Award type:** 5
- **Project period:** 2020-08-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10220170

## Citation

> US National Institutes of Health, RePORTER application 10220170, Understanding and measuring the impact of stigma on PrEP adherence among adolescent girls and young women in Kenya: identifying targets for future interventions (5R21TW011784-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10220170. Licensed CC0.

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