“Condoms are negotiable. PrEP isn’t.”
For many young people in Eswatini, the shift from condoms to pre-exposure prophylaxis (PrEP) is about autonomy and control in a world where conversations around protection can be uncomfortable, stigmatised, or even dangerous.
PrEP is a medicine taken by people at risk of HIV to prevent infection through sex or injection drug use. When taken as prescribed, it stops the virus from taking hold or spreading in the body.
Currently, two FDA-approved daily oral medications are available, alongside two long-acting injectable options: one administered every two months and the other, twice a year.
When used consistently, PrEP reduces the risk of acquiring HIV through sex by about 99% and by at least 74% among people who inject drugs. However, its effectiveness drops significantly when not taken regularly.
Surge in PrEP Uptake
According to the Ministry of Health’s first-quarter 2025 performance report, PrEP initiations surged from 5,609 in 2019 to over 30,500 in 2024.
The momentum continued into 2025, boosted by the introduction of injectable cabotegravir (CAB-LA) in August 2024, a development praised and scrutinised at the highest levels of government.
Speaking during the tabling of the ministry’s report in the Senate, Minister of Health Mduduzi Matsebula acknowledged the impressive uptake as a public health success story — but with a warning:
While the surge in PrEP reflects growing acceptance of biomedical HIV prevention, it must complement, not replace condom use.
STI Concerns
The ministry reported 6,852 sexually transmitted infection (STI) cases in the final quarter of 2024 — the highest in over two years.
Although numbers dipped slightly in early 2025, STI rates remain elevated. Minister Matsebula linked the spike to riskier sexual behaviours, including inconsistent condom use and delayed care-seeking for STI symptoms.
In response, the ministry is scaling up sexual health education, condom promotion, and targeted outreach to adolescents, mobile populations, and key populations. It is also expanding access to STI diagnostics and strengthening syndromic management in clinics.
Voices of Young People
This publication spoke with several young people who shared why they are choosing PrEP over condoms.
Raised in the age of digital health messaging and modern prevention methods, many said PrEP offers privacy, consistency, and control without needing a partner’s permission or cooperation.
For many young women, PrEP is empowering. In a society where suggesting condom use can be met with suspicion, dismissal, or even violence, PrEP allows women to protect themselves on their own terms.
“I don’t have to argue, beg, or explain,” said a 24-year-old woman who preferred to remain anonymous. “With PrEP, it’s mine. I control it.”
She is one of a growing number of young people in Eswatini choosing daily or injectable PrEP as their preferred form of protection against HIV.
A 22-year-old university student echoed these sentiments, explaining that after several awkward and confrontational experiences insisting on condom use, she gave up.
“You meet someone and bring up condoms and it turns into a thing. They ask, ‘Don’t you trust me?’ or say it ruins the mood. But PrEP? You take it quietly. No debate.”
To her, condoms feel like a negotiation, while PrEP feels like a decision.
Meanwhile, another young woman revealed she was clear-eyed about her choices:
“I know PrEP doesn’t stop everything, but at least I know I won’t get HIV. I’ll deal with the rest if I have to.”
