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Knowledge gaps and social barriers constrain PrEP uptake among university students in South AfricaUniversity students show willingness to use HIV prevention medicine

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Key Takeaway
Note that while PrEP willingness is favorable, uptake is hindered by stigma, cost, and service-related barriers.

This scoping review synthesizes evidence regarding PrEP awareness, acceptability, uptake, and adherence among university students in South Africa across several provinces. The review focuses on the interplay between individual perceptions, social influences, and systemic barriers affecting HIV prevention efforts in this specific demographic.

Findings indicate that while awareness and willingness to use PrEP are generally favorable, several factors constrain uptake and sustained use. These barriers include knowledge gaps, low perceived risk, stigma, concerns regarding side effects, and costs. Additionally, the review identifies significant social and systemic hurdles, including accessibility issues and service-related barriers. The study also notes prevalent HIV risk behaviors, such as multiple partnerships and inconsistent condom use, often influenced by socioeconomic pressures.

Clinical implications suggest that integrated, youth-friendly services are necessary to address the identified barriers. Targeted education focusing on HIV risk, stigma, and service navigation may improve informed decision-making. However, the scope of this review is limited to the specific context of South African university students, and the evidence regarding the specific impact of these interventions on long-term outcomes is not detailed.

How this fits prior evidence

This scoping review addresses gaps in understanding the specific barriers to PrEP uptake among university students in South Africa. It complements existing evidence showing that community-based PrEP delivery is linked to higher willingness and risk behavior changes in MSM, and that group support models may improve PrEP uptake and adherence for adolescent girls and young women. While this review identifies stigma and service-related barriers as key constraints, it does not provide specific data on the impact of absolute risk framing or insurance navigation on uptake.

For many university students, the choice to use PrEP—a medicine taken to prevent HIV—is a personal one shaped by social circles and personal beliefs. A review of data from several regions in South Africa shows that these students generally have a positive attitude toward using the medication to protect their health.

However, a positive attitude does not always lead to daily use. The review found that several hurdles often stop students from starting or staying on PrEP. These include gaps in knowledge, a low sense of personal risk, and concerns about side effects. Social factors like stigma and the actual cost of the medicine also play a big role in whether a student can access and stick with the treatment.

To help more students stay safe, the findings suggest that health services need to be more youth-friendly. This means providing better education to clear up misconceptions and making it easier for students to get the medicine they need. By addressing these specific barriers, health providers can help students make more informed decisions about their prevention options.

What this means for you:
Students are willing to use PrEP, but stigma, cost, and lack of knowledge often prevent them from using it.

Common questions

Are university students open to using PrEP?

Yes, the review found that awareness and willingness to use PrEP were generally favorable among university students in South Africa. While they are open to the option, their actual use of the medicine can still be limited by several outside factors like cost and social stigma.

What stops students from using PrEP consistently?

Several factors can stop students from using PrEP regularly. These include gaps in knowledge, a low perceived risk of HIV, concerns about side effects, and the cost of the medicine. Additionally, social stigma and issues with how services are delivered can make it harder for them to stay on the treatment.

What can be done to improve PrEP use among young people?

To help students make better decisions, the findings suggest using integrated, youth-friendly services. These services should focus on targeted education to address common misconceptions, reduce the impact of stigma, and improve access to the medicine for those who want to use it.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
BackgroundPre-exposure prophylaxis is an effective biomedical intervention for preventing HIV infection, yet evidence on its awareness, acceptability, uptake and adherence among South African university students remains fragmented.ObjectiveTo map and synthesize the available evidence on pre-exposure prophylaxis awareness, acceptability, uptake, adherence, and HIV-related risk behaviors among university students in South Africa.MethodsA scoping review was conducted using Joanna Briggs Institute methodology and reported according to PRISMA-ScR. Studies published between 2014 and 2026 were searched in PubMed/MEDLINE, Scopus, ScienceDirect, CINAHL, African Journals Online and ProQuest Dissertations and Theses/grey literature. Two reviewers independently screened studies and charted data using a predefined extraction tool. Findings were synthesized thematically.ResultsSixteen studies were included, of which 68.75% (n = 11) were quantitative and 31.25% (n = 5) qualitative. Evidence was concentrated in KwaZulu-Natal, Gauteng, Limpopo and the Western Cape, with most studies published from 2019 onwards. Six themes emerged: (1) Individual Level: individual perceptions, knowledge and appraisal of HIV and PrEP; (2) Interpersonal Level: interpersonal relationships and social influence on PrEP decision-making; (3) Institutional Level: accessibility, acceptability and responsiveness of PrEP services; (4) Community/social Level: stigma, misconceptions and social norms surrounding PrEP; (5) Structural Level: socioeconomic and health-system conditions shaping PrEP utilization; and (6) HIV Risk Behaviors: patterns of sexual risk and their relationship to PrEP need. Awareness and willingness to use PrEP were generally favorable, but uptake and sustained use were constrained by knowledge gaps, low perceived risk, stigma, side-effect concerns, cost, accessibility and service-related barriers. Risk behaviors included multiple partnerships, inconsistent condom use, substance-associated sexual behavior and socioeconomic pressures.ConclusionPrEP utilization is shaped by interacting individual, social, institutional and structural factors. Integrated, youth-friendly services and targeted education addressing HIV risk, stigma and access are needed to strengthen informed PrEP decision-making and prevention.
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