HIV prevention is reaching fewer adolescent girls and young women than the tools allow

About 4,000 adolescent girls and young women aged 15 to 24 acquired HIV each week in 2024, and roughly 3,300 of those infections occurred in sub-Saharan Africa, according to a new editorial published in Frontiers in Public Health. The editors behind the journal’s Research Topic on HIV prevention among adolescent girls and young women argue that this figure has not fallen in step with the prevention tools now on offer, and that the gap lies less with the products themselves than with whether young women can start and keep using them.

The editorial, written by Enos Moyo of the University of KwaZulu-Natal and Tafadzwa Dzinamarira of the University of Pretoria, introduces a collection of nine articles spanning eight countries and one global analysis. The editors note that oral pre-exposure prophylaxis (PrEP) has been recommended for nearly a decade, HIV self-testing is widely approved, and the World Health Organization added twice-yearly injectable lenacapavir to its prevention guidance in 2025. They invited work that asked who is still being missed, and why.

The studies gathered under the Research Topic point to a recurring distance between a method being available and a young woman being able to sustain its use for as long as she needs it. In one study of school-going adolescent girls in northwestern Botswana, most of whom had not yet had sex, some participants were unsure about correct condom use or held misconceptions about HIV. Girls who felt confident discussing condoms and refusing condomless sex were more likely to believe they could insist on condom use, a pattern the editors say argues for sexuality education that begins before sexual debut and gives girls room to practise these conversations.

Family and community contexts also shape prevention behaviour. Among sexually experienced students in Fuzhou, China, a study found that stronger family functioning was associated with more favourable attitudes towards HIV testing and more information-seeking, with self-monitoring explaining part of that association. The editors caution that this sample was not designed around young women, but they suggest the findings bear on how caregivers might support daughters, and that family-based approaches should protect young people’s privacy and recognise that not every home is safe.

Willingness does not always translate into use. In an informal settlement in Kampala, researchers found that young people rated HIV self-testing highly, yet far fewer had actually used a kit; cost, patchy availability, doubts about the result, and the opinions of peers and family all stood in the way. The editors describe this as one of the widest gaps the studies expose.

Programme data from Namibia show a similar pattern on the supply side. In the country’s DREAMS programme, 81.1 percent of eligible participants started oral PrEP, but the young women who did not were those with recent sexually transmitted infections, multiple or concurrent partners, or partners of unknown HIV status, as well as those in some smaller towns. The editors argue that this pattern calls for locally designed counselling and service delivery rather than national messaging alone.

Service integration raises its own challenges. An evaluation of PrEP delivered through postabortion care in Kenya, where most clients were in their twenties, found that just over half of clients received any PrEP information, and persistence among those who started was low. Clinics randomised to make scheduled phone calls retained significantly more women at one month, though the difference in refills, the trial’s primary outcome, was not statistically significant. The editors conclude that for anyone planning integration, the harder work begins after the first visit.

Choice and safety emerge as central concerns in the remaining studies. Kerrigan and colleagues found low awareness and use of PrEP among cisgender women in the Dominican Republic and the United States, yet many participants preferred a long-acting injectable to daily tablets, with preferences shaped by concerns about injections, stigma, partner violence and earlier use of injectable contraception. The editors note that this population is broader than adolescent girls and young women, but that with lenacapavir now recommended, programmes for younger women will soon face the same questions.

Finally, research from Tanzania shows how narrow choice becomes under criminalisation. Young female sex workers there described stigma, mistreatment and fear of arrest, and leaned on peers to decide where, and whether, to seek care. For them, the editors observe, a better-equipped clinic offers little if attending it carries legal risk. The editorial closes by thanking the authors, reviewers and the Frontiers editorial office, and by expressing the hope that readers will find in these articles a practical account of where prevention for adolescent girls and young women breaks down and what it would take to strengthen it.

Subject of Research: HIV prevention among adolescent girls and young women, examining barriers to PrEP initiation, HIV self-testing and sustained prevention tool use across eight countries.

Article Title: Editorial: The prevention of HIV among adolescent girls and young women: leaving no one behind

Article References: Moyo, E., & Dzinamarira, T. (2026). Editorial: The prevention of HIV among adolescent girls and young women: leaving no one behind. Frontiers in Public Health, 14, 2005756. https://doi.org/10.3389/fpubh.2026.2005756

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.2005756

Keywords: HIV prevention, adolescent girls and young women, PrEP, lenacapavir, HIV self-testing, sub-Saharan Africa, DREAMS programme, sexuality education, criminalisation, postabortion care, Frontiers in Public Health, Editorial