Contraception and PrEP in South African Hair Salons: Owner, Stylist, and Client Views

Bassett, Ingrid V.; Ai, Xu; Govere, Sabina; Thulare, Hilary; Frank, Simone C; Psaros, Christina

doi:10.1097/qai.0000000000001794

Cited by 5 publications

(8 citation statements)

References 17 publications

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“…These findings align overall with the facilitators and barriers to salon-based health service delivery identified by Bassett et al (2019) [ 25 ]; however, beyond identifying additional social factors specifically impacting contraceptive uptake, this analysis links components of the salon social environment to one another by understanding how they may impact each stage of the contraceptive decision-making process (e.g. components of the salon environment that facilitate client attention to and interest in contraceptive uptake, recommendations from stylists and clients that may mitigate barriers to comprehension).…”

Section: Discussionsupporting

confidence: 86%

“…Novel community-based venues for contraceptive delivery (i.e., on-site access to contraceptive services and/or promotion of contraceptive information) may have the potential to address interpersonal and structural barriers to contraceptive access and uptake. Hair salons in Umlazi, KwaZulu-Natal, South Africa have been previously identified as acceptable venues for delivery of contraceptives and HIV pre-exposure prophylaxis by salon owners, stylists, and clients due to their convenience and accessibility [ 2 , 25 ]. We have previously assessed the feasibility and acceptability of providing health services in salons using cross-sectional descriptive data and qualitative analyses in the service of intervention design [ 2 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hair salons in Umlazi, KwaZulu-Natal, South Africa have been previously identified as acceptable venues for delivery of contraceptives and HIV pre-exposure prophylaxis by salon owners, stylists, and clients due to their convenience and accessibility [ 2 , 25 ]. We have previously assessed the feasibility and acceptability of providing health services in salons using cross-sectional descriptive data and qualitative analyses in the service of intervention design [ 2 , 25 ]. While convenience and accessibility of salons may address structural barriers to contraceptive access, the social environment of salons may additionally impact contraceptive decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Hair salons and stylist–client social relationships as facilitators of community-based contraceptive uptake in KwaZulu-Natal, South Africa: a qualitative analysis

et al. 2021

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Background South Africa faces a high burden of unmet contraceptive need, particularly among adolescent girls and young women. Providing contraception in community-based venues may overcome barriers to contraceptive access. Our objective was to explore the potential impact of the social environment and stylist–client interactions on perceived accessibility of contraceptives within hair salons. Methods We conducted 42 semi-structured, in-depth interviews with salon clients (100% identified as female, 100% identified as Black, median age 27.1 years) and 6 focus groups with 43 stylists (95% identified as female, 98% identified as Black, median age 29.6 years) in and around Umlazi Township, Durban, KwaZulu-Natal to explore perspectives on offering contraceptive services in hair salons. We used an inductive and deductive approach to generate the codebook, identified themes in the data, and then organized findings according to Rogers’ Individual Adoption Model as applied to community-based health prevention programs. Twenty-five percent of transcripts were coded by two independent coders to ensure reliability. Results We identified elements of the salon environment and stylist–client relationships as facilitators of and barriers to acceptability of salon-based contraceptive care. Factors that may facilitate perceived contraceptive accessibility in salons include: the anonymous, young, female-centered nature of salons; high trust and kinship within stylist–client interactions; and mutual investment of time. Stylists may further help clients build comprehension about contraceptives through training. Stylists and clients believe salon-based contraceptive delivery may be more accessible due to contraceptive need facilitating client buy-in for the program, as well as a salon environment in which clients may encourage other clients by voluntarily sharing their own contraceptive decisions. The non-judgmental nature of stylist–client relationships can empower clients to make contraceptive decisions, and stylists seek to support clients’ continued use of contraceptives through various adherence and support strategies. Some stylists and clients identified existing social barriers (e.g. confidentiality concerns) and made recommendations to strengthen potential contraceptive delivery in salons. Conclusion Stylists and clients were highly receptive to contraceptive delivery in salons and identified several social facilitators as well as barriers within this setting. Hair salons are community venues with a social environment that may uniquely mitigate barriers to contraceptive access in South Africa.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hair salons and stylist–client social relationships as facilitators of community-based contraceptive uptake in KwaZulu-Natal, South Africa: a qualitative analysis

et al. 2021

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“…We assumed that half of HIV negative injectable contraceptive users will use long‐acting PrEP and injectable contraceptive use will remain stable. Data about the potential uptake of PrEP by women differ widely and the uptake will also be influenced by the effectiveness, safety, costs and side effects of long‐acting PrEP as well as implementation strategies . However, in populations using injectable contraceptives, acceptability of injectable long‐acting PrEP will probably be high and this combination could increase the use of both drugs .…”

Section: Discussionmentioning

confidence: 99%

Epidemiological impact and cost‐effectiveness of providing long‐acting pre‐exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study

et al. 2019

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Introduction Although pre‐exposure prophylaxis (PrEP.) is an efficacious HIV prevention strategy, its preventive benefit has not been shown among young women in sub‐Saharan Africa, likely due to non‐adherence. Adherence may be improved with the use of injectable long‐acting PrEP methods currently being developed. We hypothesize that providing long‐acting PrEP to women using injectable contraceptives, the most frequently used contraceptive method in South Africa, could improve adherence to PrEP, result in a reduction of new HIV infections, and be a relatively easy‐to‐reach target population. In this modelling study, we assessed the epidemiological impact and cost‐effectiveness of providing long‐acting PrEP to injectable contraceptive users in Limpopo, South Africa. Methods We developed a deterministic mathematical model calibrated to the HIV epidemic in Limpopo. Long‐acting PrEP was provided to 50% of HIV negative injectable contraceptive users in 2018 and scaled‐up over two years. We estimated the number of HIV infections that could be averted by 2030 and the drug price of long‐acting PrEP for which this intervention would be cost‐effective over a time horizon of 40 years, from a healthcare payer perspective. In the base‐case scenario we assumed long‐acting PrEP is 75% effective in preventing HIV infections and 85% of infected individuals are on antiretroviral drug therapy (ART) by 2030. In sensitivity analyses we adjusted PrEP effectiveness and ART coverage. Costs between $519 and $1119 per disability‐adjusted life‐year (DALY) averted were considered potentially cost‐effective, and <$519 as cost‐effective. Results Without long‐acting injectable PrEP, 224,000 (interquartile range 176,000 to 271,000) new infections will occur by 2030; use of long‐acting injectable PrEP could prevent 21,000 (17,000 to 26,000) or 9.8% (8.9% to 10.6%) new HIV infections by 2030 (including 6000 (4000 to 7000) in men). Long‐acting PrEP would prevent 34,000 (29,000 to 39,000) or 12,000 (8000 to 15,000) at 75% and 95% ART coverage by 2030 respectively. To be considered potentially cost‐effective the annual long‐acting PrEP drug price should be <$16, and/or ART coverage remains at <85% in 2030. Conclusions Providing long‐acting PrEP to injectable contraceptive users in Limpopo is only potentially cost‐effective when long‐acting PrEP drug prices are low. If low prices are not feasible, providing long‐acting PrEP only to women at high risk of HIV infection will become important.

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“…80% of owners, 93% of stylists, and 100% of clients were female and the average age of each group was 40, 30, and 27 years. Inclusion criteria included: Age ≥ 18 years, English or isiZulu speaking, and able and willing to provide informed consent (15). Salon owners, stylists, and clients were recruited from a convenient sample of hair salons in Umlazi Township and neighboring communities and were approached by a bilingual (English/isiZulu), female research assistant to assess their interest in participating in an in-depth interview or focus group.…”

Section: Methodsmentioning

confidence: 99%

Contraception, HIV Services, and PrEP in South African Hair Salons: A Qualitative Study of Owner, Stylist, and Client Perspectives

et al. 2019

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Background: Women experience challenges engaging with the healthcare system, but frequently utilize hair salons; these are promising venues for family planning and HIV prevention services. Our objective was to assess the acceptability of nurse-offered contraceptive and PrEP services at hair salons in Durban, South Africa. Methods: We interviewed salon owners (N=10) and clients (N=42) and conducted focus groups with hair stylists (N=43 stylists; 6 focus groups across 5 hair salons) to explore barriers and facilitators to providing contraception and PrEP in salons. After developing a codebook, we performed content analysis to identify themes within each conceptual area; 10% of transcripts were coded by two coders to ensure reliability. Results: Content was analyzed according to the following categories: 1) facilitators of and 2) barriers to utilizing these services, and 3) factors to consider for program implementation. Participants identified convenience and female-oriented, supportive atmosphere as facilitators to offering HIV and contraceptive services in salons. Owners and stylists noted that establishing legitimacy was important for program success, including providing promotional pamphlets and employing nurses. Clients cited privacy concerns surrounding HIV testing in a public space as a significant barrier to using these services. Overall, participants were enthusiastic about the program. Conclusions: Convenience and a conducive environment were noted as facilitators to receiving health services in the hair salon; attention will have to be directed to establishing privacy and program legitimacy. Hair salons represent an innovative venue for reaching young women at high-risk for unintended pregnancy and HIV infection.

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Contraception and PrEP in South African Hair Salons: Owner, Stylist, and Client Views

Cited by 5 publications

References 17 publications

Hair salons and stylist–client social relationships as facilitators of community-based contraceptive uptake in KwaZulu-Natal, South Africa: a qualitative analysis

Hair salons and stylist–client social relationships as facilitators of community-based contraceptive uptake in KwaZulu-Natal, South Africa: a qualitative analysis

Epidemiological impact and cost‐effectiveness of providing long‐acting pre‐exposure prophylaxis to injectable contraceptive users for HIV prevention in South Africa: a modelling study

Contraception, HIV Services, and PrEP in South African Hair Salons: A Qualitative Study of Owner, Stylist, and Client Perspectives

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