The Euthyphro Dilemma, Assisted Dying, and a Virtue Ethics Approach to Autonomy.

South African adolescent girls and young women (AGYW) remain disproportionately affected by HIV, with incidence rates among the highest globally []. Oral antiretroviral pre-exposure prophylaxis (PrEP) is an effective biomedical prevention strategy [], and South Africa has prioritized expanding access to PrEP through differentiated delivery models that bring services into communities, making prevention more accessible and person-centered [,]. However, even where PrEP is widely available and free of charge, persistence among AGYW remains low, with 32–38% of AGYW remaining on PrEP after one month [,]. These findings suggest that individual factors beyond access shape oral PrEP engagement. Depression and anxiety symptoms are common among young women in South Africa and may be exacerbated by experiences of poverty, violence, stigma, and other forms of social marginalization []. These mental health challenges may influence PrEP behaviors by reducing motivation or perceived self-worth. Similarly, substance use may interfere the ability of AGYW to adhere to daily PrEP regimens or maintain consistent follow-up []. Despite this, mental health and substance use assessments are rarely integrated into PrEP implementation programs, and little is known about how these factors shape PrEP outcomes in real-world settings. In this report, we examine data from a district-wide, community-based PrEP implementation program for AGYW in Cape Town, South Africa to explore the association between mental health and substance use symptoms and early PrEP persistence. Findings aim to inform more integrated HIV prevention services that address both clinical and psychosocial needs.