PrEP marketing should not be a story about HIV, but a story about young women

What do we want young women’s hearts to feel and minds to think about PrEP? This was the question a group of researchers and marketing experts sought to answer in order to build a strong, evidence-informed, and unified brand positioning for PrEP.

After reviewing all the available campaigns that focus on young women and PrEP, holding consultative meetings with key stakeholders, including group discussions with 121 young women from Kenya, South Africa, and Zimbabwe, and finally analysing the data gathered using marketing insights, the team concluded that:

“For more adolescent girls and young women to use PrEP, communication should resonate with young women’s inner strength, their unwavering determination to live a full and healthy life, and their commitment to self-care as an act of self-love.”

 “We need to reframe the PrEP category away from the medical, towards self-care as a collective and continuous act, as more caring and nurturing to inspire action from young women,” they add. “Where choice is a given, and support is available; where young women can make decisions about their health in a less prescriptive and more caring way.”

Adolescent girls and young women comprise only 10% of the population in Africa, but they account for 25% of new HIV infections. While they are a critical audience for PrEP, demand for and uptake of oral PrEP among them has not been as high as hoped, and among those who initiate oral PrEP, many do not continue to use it. As new PrEP products such as the vaginal ring and injectable cabotegravir are introduced, marketing and demand generation efforts should cover the whole ‘PrEP category’.

MOSAIC is a PEPFAR-USAID project to accelerate the introduction and scale-up of new biomedical prevention products to help women prevent HIV. Led by the non-government organisation FHI360, MOSAIC worked to find the most effective way to brand the PrEP category targeted towards young women. The goal was to align marketing, communication, and demand generation activities under a common strategy that is based on robust evidence and a deep understanding of young women's relationship with PrEP.

The approach

MOSAIC conducted a comprehensive review of all the previous PrEP demand generation work and formative research in eight countries to make use of their knowledge of what has worked and hasn't in HIV prevention demand generation.

To develop a new brand strategy, they held working sessions and workshops with MOSAIC’s youth advisors, who played a significant role in ensuring that insights from the target audience were incorporated into the strategy and resonated with young women in their respective countries. They also held consultations with MOSAIC country partners, Ministry of Health representatives, donors, advocates and activists to ensure the strategy will work in their contexts, to obtain buy-in, and to develop plans for real-world use of the work.

Findings

• For young women, PrEP is strongly associated with self-care.

Self-care for them means having the confidence to prioritise themselves and having the self-respect to take control of their health and their lives. Self-care is about making the brave choice to take care of themselves by taking PrEP. It signifies a desire to live and not to die young.

“The day you decide to take PrEP, is the day where you show that you respect yourself enough to keep you protected. You are actually respecting yourself enough to stay loyal to PrEP.” – Young woman, Zimbabwe.

• Taking PrEP provides peace of mind.

Young women are especially conscious of managing their mental well-being. PrEP is seen as an essential way to negate the anxiety. It means looking out for themselves the best way they can even when there are factors they can’t always control, like when or with whom they have sex. Leveraging the peace of mind that comes with taking PrEP is a significant benefit for adolescent girls and young women and has the potential to outweigh the challenges of PrEP use.

“As a woman, PrEP is a commitment to protect myself and promote some peace of mind, of not putting myself at risk. It’s a compliment to myself. I will protect myself.” –Young woman, South Africa

• PrEP choice puts young women in control.

Though there are things that young women often can’t control when it comes to sex, such as the HIV status of a partner or instances of sexual assault, PrEP offers them a measure of autonomy over their bodies. A sense of being in charge of decisions for their health renders them more confident in other areas of life.

“I’m free to decide. There are so many options. I choose what happens in my life and what gets into my body.” – Young woman, Zimbabwe.

•  PrEP supports young African women in putting themselves first.

African young women are less cautious of others’ expectations or traditional roles. They are not seeking permission to live up to their potential, and they seek programmes, services, and products that believe in them and support them for who they already are.

“With PrEP you are taking care of yourself, you are choosing you, choosing your wellness. Taking PrEP is about being healthy—with or without your partner’s agreement.” – Young woman, South Africa.

• It should be explicit that PrEP is not just for young women.

African young women do not wish to be stigmatised as the only target group for PrEP. Therefore, it is important to communicate that PrEP is for everyone by including diverse genders, ages, abilities, races, and sexualities in the messaging about PrEP.

“We need to see diversity…different races, traditional people, different tribes, Muslim people …otherwise, it’s “is this our problem only?” –Young woman, Kenya.

Brand positioning

Based on these findings, the researchers developed a brief to guide the development of national communications strategies and campaigns to communicate the PrEP category to young women. The positioning strategy includes a checklist for developing communication that will resonate and inspire action.

The check-list includes the following indicators:

• Show young women today. Young women want to see themselves represented in communication materials. They don’t want to see models, but rather real young women from their country and background.
• Speak to young women in their own language. Listen to how young women speak to each other, what slang they use, and how they express themselves. Be inspired by it.
• Understand that PrEP isn’t only for people in romantic relationships. While relationships are part of young women’s lives, they are not in themselves the emotional drivers for PrEP use (those are self-care, peace of mind, and control).
• Situate PrEP in the context of self-care. Young people’s reference to self-care is about taking care of their physical, mental, and emotional health, and is rooted in the desire to live a life uninterrupted by HIV.
• Acknowledge that taking PrEP is hard. Young people know it is hard to take PrEP, for multiple reasons, and don’t want the realities sugar-coated. Don’t use language like “just once a day” or “easy to use”.
• Watch out for empowerment. Don’t use language that tells them they have potential, but rather remind them that they are already living up to their potential.
• Include information on the safety of PrEP. Every interaction, whether at the clinic, through media, or in conversations with healthcare providers, should reinforce the safety of these products. They are ‘safe’ both in terms of their side-effect profile and also the emotional benefits (peace of mind, sense of control etc.) they provide.  

“PrEP use is not always easy. It requires repeat visits to the clinic, taking time off work, remembering to use a medication, managing side effects and much more. For more young women to use PrEP, the category must be linked with the audience’s sense of strength. To stand out, communication should resonate with young women’s inner strength, unwavering determination to live a full and healthy life, and commitment to self-care as an act of self-love,” the team conclude.

MOSAIC have also developed brand guidelines for the PrEP category, which includes logo reactions, colour preferences, photography and imagery. These guidelines were formulated based on feedback from young people gathered during group discussions.