Factors Affecting Access to and Utilisation of HIV/AIDS Preventive Services Among Young Single Mothers Working in...

Despite Rwanda's progress in HIV prevention for key populations, female employees in alcohol-serving establishments (ASEs) remain underserved, with interventions often lacking attention to the contextual factors shaping their HIV risk and service uptake. Guided by the Exploration phase of the Exploration, Preparation, Intervention, and Sustainment (EPIS) framework, a qualitative study was conducted to identify contextual factors affecting HIV prevention uptake among young single mothers working in informal ASEs. In-depth interviews were conducted with 101 participants recruited through maximum variation purposive and snowball sampling. Data were analyzed thematically, with findings organized according to inner and outer EPIS contextual domains. Outer context findings revealed structural and socio-cultural barriers, including unaffordability of post-exposure prophylaxis and HIV self-testing kits, inconsistent condom availability, and gender norms limiting women's autonomy in sexual health decision-making. Inner context findings highlighted workplace-related challenges, such as limited support from establishment owners, absence of HIV prevention resources within venues, and the influence of male partners and clients on women's ability to negotiate safer sexual practices. Facilitators across both contexts included HIV risk awareness, fear of unintended pregnancy, and aspirations for improved economic and social futures for themselves and their children. By systematically examining contextual influences during the EPIS Exploration phase, this study addresses a critical gap in HIV prevention research among an underserved population. These findings can inform the development of context-responsive behavioral and structural interventions aimed at improving HIV prevention uptake and addressing workplace, social, and structural drivers of HIV vulnerability in ASEs.