“Protecting ourselves in silence”

A qualitative study of HIV risk perception and prevention among women in Sierra Leone

Bibliographic Data

ID19440043
AuthorsEric Nzirakaindi Ikoona (0000-0003-3402-1961, Public Health Agency, corresponding author), Lucy Namulemo (0000-0003-0594-2956, Counselling Centre for Children, Adolescents and Parents), Ronald Kaluya (0000-0002-7577-0742, Counselling Centre for Children, Adolescents and Parents), Rebecca Ikoona (0009-0002-9821-9221, MUJHU Research Collaboration), Foday Sahr (0000-0001-9816-4502, Public Health Agency)
Year2026
Volume38
Issue9
Pages1-15
Publication date2026-03-27
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2026.2647905
PMID41891672
OpenAlexW7141422939
LanguageEN
Citations received1
References cited32

Women in Sierra Leone navigate HIV vulnerabilities shaped by gender inequities, economic dependence, and post-conflict dynamics. Despite a disproportionate burden (2.2% among women versus 1.1% among men), limited research has explored how women perceive and respond to HIV risk in low-prevalence West African settings. This qualitative study examined risk perception, vulnerability drivers, and prevention strategies through semi-structured interviews with 90 women across three districts (Western Area Urban, Bo, Kenema), including women living with HIV (n = 40), women with elevated vulnerability (n = 30), and community health workers (n = 20). Thematic analysis guided by the AIDS Risk Reduction Model identified three themes: barriers to risk recognition through psychological distancing and moral othering; factors influencing commitment, shaped by self-worth, relationship power, economic dependence, and solidarity networks; and prevention in practice, encompassing testing access, condom negotiation constraints, limited pre-exposure prophylaxis (PrEP) awareness, and substance use intersections. Psychological distancing appeared reinforced by low HIV visibility, with stronger distancing in Bo and Kenema than Freetown. Economic dependence emerged as a pervasive constraint across the risk navigation process. Findings suggest effective prevention may require addressing structural preconditions for protective action, with attention to district-level variation in HIV visibility and network dynamics. Further research is needed to test these implications

Focus group · Human immunodeficiency virus (HIV) · Perception · Qualitative research · Risk perception · Sierra leone · Adolescent Sexual and Reproductive Health · Community Health and Development · Health, psychology, and well-being