The Invisible Product: Preferences for Sustained-Release, Long-Acting Pre-exposure Prophylaxis to HIV Among South African Youth

Abstract

male condoms applied using finger, female condoms vaginally inserted using fingers, both used during sex.  Oral Pills: orally administered, used daily (one tablet at around the same time every day).  Implants: flexible plastic rods placed under the skin of the upper arm, inserted every 3-5 years.  Injectable: a shot that contains hormones that stop your body from releasing eggs and thickens the mucus at the cervix, received once every 1-3 months from a healthcare provider.  Vaginal Gel/Spermicide: a chemical in the form of a cream, film, foam, gel or suppository that is vaginally administered before sex. Pregnancy Prevention only: Diaphragm: a shallow, dome-shaped silicone cup with a flexible rim that is inserted into the vagina prior to sex.  IUD: a small contraceptive device, often 'T'-shaped, that is inserted into the uterus, effective for 3-10 years. Male and female sterilization: a permanent form of contraception. Female sterilization involves cutting, sealing, or blocking the fallopian tubes, which carry an egg to the womb. Male sterilization includes cutting, sealing, or tying the tube that carries the sperm to the testicles.  Traditional/rhythm method: traditional methods of contraception include abstinence, withdrawal, and rhythm methods. The rhythm method, also known as the calendar method works by tracking a woman's menses and predicting the times when a woman is fertile and avoiding unprotected sex during those times.

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

“…Nevertheless, the near-invisibility of PrEP use allows women to protect themselves effectively without consultation, permission, or participation from male partners, making PrEP a unique HIV prevention strategy compared to the typical male-controlled strategies (e.g., condoms) that require cooperation (Flash et al, 2014;Montgomery et al, 2019). A qualitative study of 92 South African youth, including 62 young women, reported that the invisibility of PrEP emerged as an important user preference, with participants highlighting they did not always wish to disclose their PrEP use to partners (Montgomery et al, 2019).…”

“…Nevertheless, the near-invisibility of PrEP use allows women to protect themselves effectively without consultation, permission, or participation from male partners, making PrEP a unique HIV prevention strategy compared to the typical male-controlled strategies (e.g., condoms) that require cooperation (Flash et al, 2014;Montgomery et al, 2019). A qualitative study of 92 South African youth, including 62 young women, reported that the invisibility of PrEP emerged as an important user preference, with participants highlighting they did not always wish to disclose their PrEP use to partners (Montgomery et al, 2019). Similarly, several qualitative studies of women both in the U.S. and in sub-Saharan Africa have emphasized the importance of oral PrEP's discreetness, allowing women to forgo conversations about protection and trust while protecting themselves from HIV (Bond & Gunn, 2016;Flash et al, 2014;Van der Elst et al, 2013;Van der Straten et al, 2014).…”

“…PrEP provides an unparalleled strategy for women facing condom coercion, reproductive coercion, and lopsided or abusive relationship power dynamics (or even IPV) by removing the need for partner cooperation. Despite this flexibility, some women have expressed that further invisibility, in the form of longeracting forms of PrEP could make PrEP that much more useful to them (Montgomery et al, 2019;Van der Straten et al, 2017;Willie et al, 2020).…”

Long-acting injectable cabotegravir for the prevention of HIV infection

“…44 In populations at elevated risk of HIV infection, long-acting injectable regimens have also been hypothetically viewed favorably, although fear of needles and concerns about the duration of therapeutic efficacy may be barriers in some individuals. 8,9,[45][46][47][48] Again, retention rates, and quantitative and qualitative perspectives in direct headto-head comparisons with daily oral TDF/FTC in ongoing Phase 3 studies, will be very informative for implementation and scale-up should safety and efficacy be demonstrated.…”

“…Furthermore, injectable technologies have repeatedly been viewed favorably among key popultions. 8,9 Rilpivirine, a non-nucleoside reverse trancriptase inhibitor (NNRTI), has been shown to have efficacy in HIV treatment when delivered as injectable anti-retroviral maintenance therapy in combination with cabotegravir in persons living with HIV (PLWH) who have not previously experienced virologic failure. 10 However, despite being safe, well-tolerated, and acceptable for PrEP in key populations, long-acting rilpivirine for PrEP has not moved forward into phase 3 studies due to storage and transportation limitations (cold chain required) and a low barrier to resistance.…”