Date of Graduation

8-2025

Document Type

Thesis

Degree Name

Master of Science in Agricultural Economics (MS)

Degree Level

Graduate

Department

Agricultural Economics and Agribusiness

Advisor/Mentor

Nalley, Lawton

Committee Member

McFadden, Brandon

Second Committee Member

Mitchell, James

Keywords

HIV, prophylaxis

Abstract

South Africa (SA) has 7.7 million citizens (12.6% of its 2023 population) living with human immunodeficiency virus (HIV). The use of pre-exposure prophylaxis (PrEP) as an antiretroviral medication for HIV-negative individuals is a promising HIV prevention strategy in SA that can help the attainment of an HIV free generation. PrEP offers greater than 90% protection against HIV acquisition. Despite SA’s efforts in increasing PrEP coverage for its citizens, primarily to those at substantial risk, its adoption remains relatively low. Structural barriers related to access, costs, lack of awareness, and, more recently, US funding cuts exacerbate the challenges of PrEP’s potential and continued adoption. To explore intentions of PrEP adoption, we simultaneously measured constructs from the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) in two samples (adults and caregivers of adolescents). Data was collected from approximately 801 adults and 690 caregivers of adolescents aged 13 to 17 years. Classifying these samples further into the high/target and low/non-target populations for PrEP based on perceived risk allowed the study to focus on differences in intention to adopt PrEP among those at substantial risk of HIV versus those who are not, and understand how caretakers of adolescents view or support PrEP adoption by their children. Estimates from structural equation modeling (SEM) results revealed that perceived susceptibility significantly influences intentions to adopt PrEP across both samples and risk groups. However, notable variations exist in the predictors of PrEP adoption intention between Adult and Adolescent samples in their target and non-target populations. While Adults in both target and non-target populations are strongly influenced by cues to actions, perceived barriers related to costs and access, together with cues to action, they carried an amplified effect in predicting adoption of PrEP for those in target populations. In adolescents, self-efficacy strongly influenced both risk populations. However, its impact is reduced or reversed when barriers to adoption exist. Target populations exhibited complex predictor relationships, with perceived benefits and subjective norms being positive predictors for PrEP adoption intentions and perceived severity having a small adverse impact. The study highlights the importance of tailored interventions to facilitate the expansion of PrEP adoption and points out the sustainable long-term demand for PrEP hinging on public health policies, HIV prevention response funding model leaning on increasing domestic healthcare funding to prevent its collapse. Amid the abrupt reduction and shutdown of foreign US funding, the proposed interventions remain easily eroded by financial gaps. Policymakers are pressed to implement immediate service gaps, public health policies that are sensitive to group differences in order to serve the specific needs of these populations and counteract growing barriers in the short term.

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