Margaret A. Atieno, LVCT Health
Katie Williams, FHI 360
The landscape of HIV prevention is rapidly evolving, poised to enter an era of unprecedented possibilities with multiple biomedical prevention products on the horizon. Innovations such as oral pre-exposure prophylaxis (PrEP), dapivirine vaginal rings (PrEP rings), and injectable cabotegravir for PrEP (CAB PrEP) will soon be more accessible.
Emerging products provide more options and the potential for individuals to find the HIV prevention methods that best suit their needs and preferences. But what does PrEP choice look like, and how can it be protected for all individuals who could benefit from HIV prevention?
To operationalize this call for choice, MOSAIC developed a set of eight principles that were published in The Lancet HIV in April 2023. The principles concretize what choice means at different levels of the HIV prevention ecosystem and offer checkpoints of accountability by contextualizing the opportunities and barriers to supporting choice in practice.
This blog post presents the principles, offers illustrative examples of each principle, and outlines what could come next to advance choice in HIV prevention efforts.
Expanding choice: The principles
The HIV prevention choice principles promote individual autonomy, dignity, and informed decision-making. They prioritize inclusivity and recognize that individuals have distinct needs and preferences that influence their PrEP options and their perceived benefit. The principles are:
HIV prevention markets allow individual’s choice of whether to use any method and what prevention option to use at a given time in a manner that is voluntary and free of discrimination, coercion, or violence.
Example: The decision on whether to use any method and what option to use is recognized as the individual’s own and is supported by health care workers.
The widest potential array of viable HIV prevention options, supplies, and equipment are in stock for users in a specific market.
Example: Prevention methods are intentionally considered in product introduction and planning, especially as integrated and differentiated service delivery continues to expand across the health sector.
HIV prevention markets support individual choice without physical, cost-based, interpersonal, or informational barriers or other restrictions to access.
Example: Product developers are incentivized to pursue accessible pricing for end users, e.g., through generic manufacturing or sublicensing agreements.
HIV prevention markets are gender-sensitive and person-first, based on medically accurate and comprehensive information, and are responsive to market demand.
Example: Methods meet the spectrum of user preferences and needs, which change over time and vary by individual user.
HIV prevention markets include options and services (technical and interpersonal) that are of the highest possible quality, and products are quality-assured.
Example: HIV prevention products are of the highest quality and are quality-assured and monitored by a stringent regulatory authority and robust pharmacovigilance systems.
Privacy and confidentiality
HIV prevention markets protect and uphold the privacy of individuals, including the confidentiality of medical and other personal information.
Example: Individuals are reassured that no personal information about their HIV status, choices, or preferences is shared with anyone but necessary medical professionals.
HIV prevention markets meaningfully and inclusively engage communities (particularly people directly affected by HIV) in all aspects of HIV prevention research, program and policy design, implementation, and monitoring; they are also adaptive to how these communities might change over time.
Example: Demand generation and prevention programming thoughtfully include or target individuals and geographies with high transmission rates.
HIV prevention markets have accountability mechanisms in place to respond to community and client feedback at all levels of the market.
Example: Individuals know where to seek redress for grievances.
Advancing choice: A call to action
Stakeholders at national and global levels must commit to upholding the principles of choice in HIV prevention. Governments, policymakers, researchers, program implementers, and advocates should collaborate to establish guidelines and frameworks that prioritize individual agency and inclusivity. Investments in research, development, and implementation of prevention methods must align with these principles, ensuring that individuals have the autonomy to make informed decisions about their sexual health. By fostering choice at all phases of the HIV prevention market, we can enable individuals to take control of their lives and reduce the impact of HIV on a global scale.
While choice is a fundamental aspect of HIV prevention, its implementation must consider the unique contexts in which individuals live. Sociocultural factors, health care systems, and resource availability can significantly influence the feasibility and acceptability of different prevention methods. Therefore, efforts to introduce and scale-up prevention products must be tailored to specific populations, ensuring that they align with local norms, beliefs, and practices. Customizing strategies and counseling and involving community stakeholders in decision-making processes can foster greater acceptance and uptake of prevention options.
As the HIV prevention landscape evolves, embracing the choice principles has become increasingly important. Upholding the principles of choice requires collaboration, accountability, and a commitment to equity. All three are critical to realizing the promise of effective HIV prevention, underpinned by choice that is upheld across the product introduction pathway.
Featured Graphic: Bridger Trap, FHI 360