# Identifying sexual behavioural choices when commencing pre-exposure prophylaxis: Findings from a public health facility in eThekwini, KwaZulu-Natal, South Africa

## TL;DR

This study explores sexual behaviors among people starting HIV prevention in South Africa, highlighting risks like transactional sex and early sexual debut.

## Contribution

The study provides insights into behavioral patterns linked to HIV vulnerability among PrEP initiators in a South African context.

## Key findings

- Early sexual debut is significantly associated with having more lifetime sexual partners.
- Transactional sex is more common among single women aged 18 to 24 years.
- Age-disparate relationships are prevalent among participants aged 18 to 24 years.

## Abstract

HIV/AIDS continues to be of concern, particularly in South Africa, where the current prevalence is 12.7%.

This study aimed to explore sexual practices that increased HIV vulnerability among clinic users who chose to initiate pre-exposure prophylaxis (PrEP) in KwaZulu-Natal, South Africa.

A quantitative approach was utilised to collect data at an urban clinic in eThekwini (n = 376). Data were analysed using SPSS v29.

Participants were predominantly female (n = 331; 88%), single (n = 343; 91.5%), and heterosexual (n = 368; 98.1%). Sexual debut occurred at 18.4 ± 2.58 years. More men reported having concurrent sexual partners (n = 24; 54.5%). Transactional sex was more often reported by single women aged 18 years to 24 years. Age-disparate relationships were more common among those aged 18 years to 24 years. A significant association between early sexual debut and the number of lifetime partners was identified (P < 0.001).

Our findings indicate that the study population was aware of their increased HIV vulnerability and were willing to try preventive measures, such as PrEP, to protect against seroconversion. However, interventions are required to abate the cycle of transactional sex, age-disparate relationships, and early sexual debut, especially among young women aged 15 years to 24 years.