Awareness, access to and uptake of HIV prevention interventions among youth in Zimbabwe: a population-based survey

Background: Youth in southern Africa continue to be at high risk of HIV infection. We investigated the awareness of, access to, and uptake of HIV prevention interventions (pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), voluntary medical male circumcision and condoms) among youth in Zimbabwe. Methods: A population-based survey of youth aged 18-24 years in 24 communities across three provinces was conducted between October 2021 and June 2022. An interviewer-administered questionnaire collected sociodemographic and sexual behaviour data including awareness of, access to, and use of HIV preventative interventions. Data were analysed using descriptive statistics and mixed-effects logistic regression weighted for clustering. Results: We recruited 17,682 youth (60.8% female, median age 20 years (Interquartile range 19-22)). Altogether 46.8% (n = 3634) of unmarried youth and 5.6% (n = 3538) of married youth reported consistent condom use and 49.8% (n = 3369) of men reported being circumcised. Awareness of PrEP and PEP was 11.2% and 11.9% respectively. 6900 participants (38.4%) reported at least one eligibility criterion for PrEP. Eligibiltiy criteria included having multiple partners or receiving money or goods for sex in the last year, HIV-negative individuals in serodiscordant relationships, those who had ever been treated for an STI, ever injected drugs, been pregnant or taken PEP. In comparison to the non-eligible population (n = 10782), the eligible population were more likely to have heard of PrEP (13.5% vs. 9.9%, p < 0.001), been offered PrEP if they had heard of it (17.0% vs. 6.3%, p < 0.001) and to have ever taken PrEP if offered it (60.7% vs. 27.0%, p < 0.001). Those in the richest wealth quintiles and with higher education level were more likely to have heard of PrEP and report regular condom use. Forty-two of 199 (20.2%) who reported having experienced forced sex in the last year sought healthcare afterwards, of these 17 of 42 (36.0%) had been offered PEP and 12 of 17 (63.7%) had ever taken it. Conclusions: Use of HIV preventive interventions remains limited among youth despite longstanding HIV programmes. Lack of awareness limits use of PrEP and PEP. There are underlying socioeconomic barriers limiting awareness of and demand for condoms, circumcision and pharmacological prophylaxis. These must be urgently addressed. Trial registration number: NCT03719521.