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

Abstract

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.

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

“…Participant characteristics were previously described [ 2 ]. Briefly, 100% (n = 42) of clients and 93% (n = 40) of stylists identified as female, 100% (n = 42) and 98% (n = 42) as Black, and the median ages of each group were 27.1 and 29.6 years, respectively.…”

“…Interviews were conducted from September 2017 to May 2018. Data collection procedures were previously described in detail [ 2 ]. The interviewer (ND) was a female research assistant fluent in English and isiZulu and trained in qualitative interviewing.…”

“…Women in sub-Saharan Africa are disproportionately impacted, with an annual rate of 91 unintended pregnancies per 1000 women aged 15–49 years, 30% higher than the global rate. Of these, nearly half occur among adolescent girls and young women (AGYW) ages 15–24 [ 2 ].…”

“…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 ].…”

“…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.…”