Hair salons as a promising space to provide HIV and sexual and reproductive health services for young women in Lesotho: a citizen scientist mixed-methods study

Malena Chiaborelli, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland. malena.chiaborelli@usb.ch.
Mamaswatsi Kopeka, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Pontšo Sekhesa, The HUB, Morija, Lesotho.
Madeleine Sehrt, Colorado School of Public Health, University of Colorado, Denver, USA.
Tsepang Mohloanyane, Central University of Technology, Bloemfontein, South Africa.
Tala Ballouz, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Dominik Menges, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Jennifer A. Brown, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
Jennifer M. Belus, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
Felix Gerber, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
Fabian Raeber, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
Andréa Williams, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
David Jackson-Perry, Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
Meri Hyöky, The HUB, Morija, Lesotho.
Donaldson F. Conserve, Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Karen Hampanda, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Denver, USA.
Alain Amstutz, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.

Document Type

Journal Article

Publication Date

7-2-2025

Journal

BMC public health

Volume

25

Issue

1

DOI

10.1186/s12889-025-23435-3

Keywords

Citizen science; HIV; Hair salon; Lesotho; Sexual and reproductive health; Young women

Abstract

INTRODUCTION: Adolescent girls and young women in southern Africa are disproportionately affected by HIV and sexual and reproductive health (SRH) challenges. There is a need for more accessible and de-medicalized community spaces to offer 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 mixed-methods approach, whereby hair stylists were recruited through social media, completed questionnaires, and recruited women clients aged 15-35 years as respondents. A stepwise verification process including GPS, pictures, and a local mobile payment system ensured data quality. Subsequently, we conducted individual in-depth interviews among 14 stylists and clients, following the rapid thematic analysis framework, supported by natural language processing. Clients and stylists were involved at the design, implementation, and results interpretation stage. RESULTS: We recruited 157 hair stylists (median age 29; [interquartile range 25-33]; across all ten districts of Lesotho) and 308 women 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, 93.5%, 88.3%, and 86.4% felt comfortable receiving the above-mentioned services, respectively. Immediate demand for the three services was 30.8%, 22.1%, and 14.9%. Acceptability and demand were higher for family planning methods and menstrual health products. 90.4% of stylists thought that offering HIV/SRH services would positively impact their business. The majority of clients visit their salon once or twice a month. Salons were more accessible than the nearest health facility in terms of cost and time, but only 21.0% have an additional confidential space. Qualitative analysis confirmed high acceptability of hair salons as an accessible, less judgemental space than clinics, but raised concerns regarding confidentiality and stylists' roles. CONCLUSIONS: This study suggests that offering HIV/SRH services in hair salons in Lesotho seems to be largely acceptable and feasible with some addressable barriers, based on survey data. A pilot intervention, guided by this study's recommendations, is warranted to translate these findings into practice.

Department

School of Medicine and Health Sciences Student Works

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