Closing the gap in HIV prevention:
Let youth voices map the way forward
JOHANNESBURG, 28 May 2026 – Too many young South Africans start HIV prevention but don’t stay on it long enough to be protected, according to new research released by youth sexual and reproductive health organisation Shout-It-Now (Shout). The study, which was funded biopharmaceutical company by Gilead Sciences, was conducted independently by Shout-It-Now ahead of the country’s planned rollout of long-acting injectable PrEP this year.
Shout shared their research findings from Phase One of their study: Landscape Analysis for Integrated, Differentiated, People-Centred HIV Prevention For Adolescents And Youth in South Africa, at an event in Johannesburg on 26 May, bringing together partners, policymakers and youth to discuss how the findings can shape HIV prevention policy and services in future.
South Africa has one of the highest HIV rates in the world and young people, especially girls and young women, are at greatest risk. But while oral pre-exposure prophylaxis (PrEP) is widely available, many stop taking it too soon to avoid infection.
The new study provides insight into the challenges and barriers young people face when it comes to HIV prevention, their preferences and ways to promote oral and long-acting PrEP use. The researchers analysed data from 97 138 oral PrEP clients over five years, alongside focus groups, a youth roundtable and a literature review, with a particular focus on adolescent girls and young women aged 18 to 24.
Key insights from the Shout programme data included that system failures such as stock shortages, lack of privacy, stigma and limited clinic hours and accessibility mean almost half of those who stop taking PrEP do so within a month, and 68% by week 10.
Around 75% of the respondents said they would prefer long-acting injectables to daily pill-taking because it would be more convenient and easier to sustain.
The respondents also indicated an overwhelming preference for accessing mobile PrEP services, with 70% saying they would prefer friendlier, more accessible facilities close to their schools or on their campuses, with less judgemental staff and higher discretion.
Many young people drop off prevention programmes quickly, but the research suggests that adequate support could prevent discontinuations. “Young people are not passive recipients of healthcare. They have diverse needs, relationship dynamics, motivations and challenges. They want choices that suit their lifestyle,” said Shout- It-Now CEO Dr Ntombifikile Mtshali.
One way to do this is through youth-friendly digital tools such as the AI chatbot “companion” Self-Cav, Shout-It-Now launched in partnership with the National Department of Health, and Audere Africa in November last year. The platform already provides thousands of young South Africans with health-related reminders, motivational support and real-time responses via WhatsApp.
Dr Ntombifikile Mtshali, CEO of Shout-It-Now
The insights from the Shout study are particularly relevant in light of Minister of Health Aaron Motsoaledi’s recent announcement that South Africa will soon be rolling out long-acting injectable PrEP administered via injection twice a year, offering six months of continuous protection per dose.
The department will start with 360 health facilities in high-burden districts, with adolescent girls and young women up to 24 among the specific target groups.
Dr Mtshali emphasised that what’s going to be important now is integrated healthcare delivery systems. “We already have PrEP and the demand for it. By investing in flexible, stigma-free delivery and trusted communication, we can build a system that meets young people on their own terms, prevent tens of thousands of new HIV infections a year, and move ever closer to the country’s goal of finally eliminating HIV/Aids as a public health threat,” she said.
The participants discussed the importance of differentiated PrEP service delivery to youth, how to “close the first 10-weeks gap” and addressing the stigma and barriers young people encounter in accessing HIV prevention methods.
“As young people, we are often invited into conversations after decisions have been already made… We are consulted at the end instead of in the beginning… youth participation must be real, not being included for just visibility, because when we help shape solutions and the outcomes change,” said panellist Puleng Mashigo from the South African Learner Support Organisation, a Shout-It-Now programme partner focused on economic strengthening support.
The seminar concluded with a collective call for HIV prevention efforts that move beyond biomedical innovation alone towards youth-centred, resilient and community-responsive systems of care. Stakeholders emphasised that the future of prevention will depend not only on new technologies, but on meaningful youth engagement, trust, accessibility and sustained investment in people-centred healthcare systems.
“Our findings make it clear that successful uptake of new biomedical HIV prevention tools cannot rely on products alone. It requires holistic systems thinking that addresses the realities young people face every day,”Dr Mtshali added. “If we want these interventions to succeed, we must co-create solutions with young people, centre their voices in policy and programme design and recognise the importance of meeting them where they are, not where systems assume they should be.”
Youth speaker Puleng Mashigo from the South African Learner Support Organisation, a
Shout-It-Now programme partner focused on economic strengthening support
About Shout-It-Now
Shout-It-Now is an NGO providing youth-focused health services and support across South Africa, with a primary focus on sexual and reproductive health, as well as mental health and wellbeing. The organisation also offers services for individuals affected by violence and exploitation. These services are delivered through multiple channels, including mobile clinics and digital engagement platforms supported by custom-designed technology.
Media Contact
Pontsho Pilane
External Affairs Director
076 142 5612
pontsho.pilane@shoutitnow.org