Background: Although multiple socioeconomic and behavioral factors have been linked to variations in HIV prevention efforts, there is limited evidence on the determinants of pre-exposure prophylaxis (PrEP) awareness among adolescents and young adults in Botswana. This study aimed to evaluate factors associated with PrEP awareness in this population.

Methods: A cross-sectional analysis was performed using data from the 2021 Botswana AIDS Impact Survey (BAIS V) (N=1,830). Participants were sexually active adolescents and young adults aged 15–24 years. PrEP awareness was assessed using the question “Have you ever heard of PrEP before now?” (no/yes). Descriptive statistics, bivariate analyses, and multivariable logistic regression were conducted to identify factors associated with PrEP awareness.

Results: Overall, 31.9% of participants reported being aware of PrEP. In the multivariable analysis, females (compared to males) had significantly higher odds of PrEP awareness (adjusted odds ratio [AOR]=2.11, 95% confidence interval [CI]=1.54–2.88, p<0.001). Relative to the poorest wealth category, participants in the poorer (AOR=2.05, 95% CI=1.30–3.23, p=0.002), middle (AOR=1.80, 95% CI=1.11–2.94, p=0.018), rich (AOR=2.20, 95% CI=1.27–3.81, p=0.005), and richest (AOR=3.46, 95% CI=1.98–6.08, p<0.001) quintiles demonstrated progressively higher odds of PrEP awareness. Additionally, individuals who had ever discussed HIV with a parent or guardian (compared to no discussion) were more likely to be aware of PrEP (AOR=1.74, 95% CI=1.24–2.40, p=0.001).

Conclusions: In this population-based survey of sexually active adolescents and young adults aged 15–24 years in Botswana, female gender, higher household wealth, and having ever discussed HIV with a parent or guardian were significantly associated with greater PrEP awareness. Targeted initiatives that address socioeconomic disparities and encourage open family communication may improve PrEP awareness in this key demographic.