The Influence Of Perceived Hiv Risk And Social Support On Willingness To Use Pre Exposure Prophylaxis Among Pastoralist Youth In Southern Ethiopia

BACKGROUND: Pastoralist youth, whose mobile livelihoods often restrict access to consistent healthcare, face elevated risk of HIV acquisition yet limited engagement with conventional prevention services. Pre-exposure prophylaxis (PrEP) offers a promising biomedical prevention option; however, little is known about the factors influencing PrEP willingness in this marginalized population. OBJECTIVES: This study aimed to: (i) examine whether HIV risk status, derived through latent class analysis (LCA), predicts willingness to use PrEP; (ii) assess whether perceived HIV risk mediates this association; and (iii) determine whether social support moderates the mediation pathway. METHODS: A community-based cross-sectional survey was conducted among 638 randomly selected pastoralist youth aged 15–24 years in Southern Ethiopia (April–May 2024). HIV risk status (independent variable) was generated using LCA based on nine HIV risk indicators. Perceived HIV risk (mediator), social support (moderator), and willingness to use PrEP (dependent variable) were measured using interviewer-administered questionnaires. Hypothesized pathways were tested using Hayes’ PROCESS macro (Model 4 for mediation; Model 15 for moderated mediation) with 5,000 bootstrap samples. RESULTS: Overall, 40.4% of participants reported definite willingness to use PrEP. High-risk youth showed significantly greater PrEP willingness than low-risk youth (direct effect, ß = 0.92, p < 0.001). Perceived HIV risk partially mediated the association between high HIV risk and PrEP willingness (indirect effect, ß = 0.20, 95% CI 0.10–0.35). Furthermore, social support significantly moderated the perceived-risk ⁵ PrEP willingness pathway among the high-risk group (index of moderated mediation = 0.21, 95% CI 0.03–0.43), with the mediated effect increasing from 0.12 to 0.35 as social support improved. CONCLUSION: Our findings indicate that PrEP willingness is higher among pastoralist youth at higher objective HIV risk. This association is partly explained by their perceived HIV risk. Crucially, stronger social support enhances the likelihood that youth who perceive themselves at risk express willingness to use PrEP. These findings underscore the importance of integrating targeted risk communication with community-based support systems to enhance accurate risk perception and promote PrEP uptake among pastoralist youth.