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Expanding PrEP
Expanding PrEP Choices and Accessibility in Africa: An Advocate’s Thoughts From HIVR4P

Released: November 04, 2024

Expiration: November 03, 2025

Violet Zulu
Violet Zulu,
Activity Information

Activity

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Key Takeaways
  • Expanding HIV pre-exposure prophylaxis (PrEP) options is crucial for increasing accessibility and meeting population-specific preferences, especially in Africa.
  • Addressing stigma, structural barriers, and costs is essential for improving PrEP uptake, particularly among hard-to-reach and key populations such as in Africa.

As an advocate living with HIV, I have witnessed the devastating impact this disease has on individuals and communities. Although I have not personally used pre-exposure prophylaxis (PrEP), I firmly believe that expanding PrEP options is crucial. My experience living with HIV highlights the critical importance of prevention, as well as the need for accessible, effective, and stigma-free prevention methods.

The introduction of PrEP with injectable cabotegravir and dapivirine vaginal ring, and the potential for injectable lenacapavir, offers renewed hope for HIV prevention. Studies presented at HIVR4P conducted in Uganda found that 58.5% of participants preferred injectable PrEP, and a discrete choice experiment in Malawi revealed that 91% of 550 participants preferred injectable PrEP over oral options. To me, these studies demonstrate a strong preference for flexible HIV prevention methods. I believe expanding choice can improve uptake.

Despite these advancements, significant disparities persist among hard-to-reach populations, underscoring the need for integrated PrEP services, economic strengthening interventions, and comprehensive counseling needs. In Malawi, 18% of participants cited stigma as a significant barrier to PrEP use. As someone living with HIV, I have personally experienced stigma and judgement, further highlighting the importance of creating judgement-free healthcare environments. 

The findings from the Malawi study highlight the need to understand population-specific preferences for HIV prevention. Policymakers must prioritize improving accessibility by addressing stigma and structural barriers. By advancing HIV prevention efforts, it is possible to envision a future where HIV transmission rates significantly decline, as seen in Uganda.

Education, awareness campaigns, integrated behavioral health support, and community engagement are vital to improving HIV prevention efforts. Policymakers, healthcare professionals (HCPs), and advocates must prioritize making PrEP accessible and offer a range of prevention options to choose from. Limited PrEP options can have devastating consequences, and expanding options can save lives and transform communities.

Policymakers must address stigma, structural barriers, and costs by combining biomedical advancements with robust behavioral health frameworks. In Uganda, 85% of participants expressed a desire for PrEP services to be integrated into existing healthcare systems. Addressing disparities, particularly among key populations, is crucial to progress.

Expanding Access 
To achieve broad accessibility, integrated PrEP services are necessary, along with wide availability of injectable PrEP and the PrEP ring. Economic strengthening interventions, comprehensive counseling, and education campaigns are essential to supporting these efforts. Community engagement is also important for raising awareness about PrEP options and addressing stigma.  

As someone living with HIV, I have seen the damaging effects of stigma firsthand. It is important to prioritize nonjudgmental, comprehensive counseling. Expanding PrEP accessibility requires addressing structural barriers, ensuring affordable pricing, and increasing public awareness of PrEP options. 

Key Populations
Reflecting on the progress made towards HIV prevention, I’m reminded of the transformative power of PrEP. However, I’m aware of significant barriers hindering accessibility. To fully harness the potential of HIV prevention, it is essential to address disparities and tailor PrEP services to meet the needs of women, to engage youth, and to prioritize key populations such as sex workers, men who have sex with men, and transgender individuals. Innovative technologies, including mobile health solutions and social media campaigns, offer additional promise for increasing engagement. Capacity-building initiatives, including HCP training and strengthening community organizations, are vital to the success of these efforts.

Global solidarity and a human rights–based approach are imperative. Integrating mental health services, addressing trauma, and promoting holistic well-being are critical for fostering resilience and adherence. Economic empowerment initiatives, such as entrepreneurship programs, further support these goals.

As an advocate, I urge policymakers, HCPs, and community leaders to join forces in breaking down barriers and expanding PrEP accessibility. Together, it is possible to close the gap between availability and uptake, accelerating progress toward HIV epidemic control. Let’s unite by harnessing hope, transforming lives and communities, and shaping a future where HIV transmission rates decline and those living with HIV thrive without stigma or fear. 

Your Thoughts?
In your clinical practice, How do you address barriers to PrEP uptake in your practice, particularly among hard-to-reach populations? Share your experiences and insights by leaving a comment below.