'Protection without negotiation': oral PrEP, sexual self-protection, and gender power among university students in South Africa.

Young women in sub-Saharan Africa continue to experience a disproportionate burden of HIV infection despite expanding biomedical prevention strategies such as oral pre-exposure prophylaxis (PrEP). While PrEP has been promoted as a woman-controlled prevention method, less is known about how its use is shaped by gendered power relations and relational contexts. This study contributes to understandings of HIV prevention by examining how female university students in South Africa experience and negotiate PrEP within intimate relationships. Informed by an interpretive qualitative design guided by feminist relational perspectives, in-depth interviews were conducted with twelve female university students, the majority of whom had not personally used oral PrEP. Findings highlight how PrEP is seen as a method used as a form of self-protection within unequal relationship dynamics, enabling women to manage HIV risk while navigating stigma, secrecy, and challenges around disclosure and trust. Women described practices that reflected 'protection without negotiation,' where prevention occurs without confrontation or reliance on partner cooperation. These findings demonstrate how PrEP operates as a relational strategy embedded within gendered social contexts rather than as an biomedical prevention intervention alone. Future HIV prevention programmes should take relational dynamics and gendered power structures into account when supporting women's engagement with PrEP.