Background
Adolescent girls and young women in southern Africa are disproportionately affected by HIV and sexual reproductive health (SRH) challenges. There is a need for more accessible and de-medicalized community spaces to offer person-centred HIV/SRH services for this key population. We aimed to assess the acceptability and feasibility of offering HIV/SRH services at hair salons in Lesotho.
Methods
We used an innovative citizen scientist approach, whereby hair stylists were recruited through social media (https://hairsalonproject.com/), completed their questionnaires, and subsequently recruited their clients aged 15-35 years as respondents. All questionnaires were co-developed with stylists/clients and a stepwise verification process using GPS, pictures and a local mobile payment system ensured data quality. In addition, we conducted individual in-depth interviews among 14 stylists/clients, following the rapid thematic analysis framework, supported by natural language processing. The protocol is registered (osf.io/VP8WZ).
Results
During 4 months (Apr – Jul 2024), we recruited 157 hair stylists (median age 29; [interquartile range 25-33]; 157 salons across all ten districts) and 307 female clients (median age 26 [22-30]). Among stylists, 93.6% were comfortable offering oral HIV self-testing (HIVST), 92.4% pre-exposure prophylaxis (PrEP), and 91.7% post-exposure prophylaxis (PEP). Among clients, the corresponding proportions were 93.5%, 88.3%, 86.4%, respectively. However, immediate demand was 30.8% for HIVST, 22.1% for PrEP and 14.9% for PEP. Acceptability and demand were higher for family planning methods and menstrual health products (Figure 1). Only 10.8% of stylists thought that offering HIV/SRH services would negatively impact their business; 81.5% have a toilet on-site, 21.0% an additional confidential space. The majority of clients visit their salon 1-2 times monthly. Hair salons were more accessible than the nearest healthcare centre in terms of cost and time. The qualitative analysis confirmed the high acceptability of the hair salon as a low-threshold access space and less judgemental than clinics, but raised concerns regarding confidentiality.
Conclusions
These findings suggest high acceptability and feasibility of HIV/SRH services at hair salons in Lesotho, providing the basis for a pilot intervention. Further research needs to examine the discrepancy between the hypothetical acceptability and immediate demand, the role of stylists, and individual components of the service package.