Katrina Ortblad

This session included presentations that discussed how we can work with communities to prepare them for the delivery of new HIV prevention interventions. Specifically, the session addressed how we might overcome multilevel barriers to PrEP access/use (e.g., stigma, medical mistrust, affordability) though clear communication, policy change, and novel delivery models.

Dr. Renee Heffron (University of Washington) discussed the PrEP products of today/tomorrow and the multilevel barriers and interventions that might facilitate PrEP access and use in sub-Saharan Africa. For example, delivering user-controlled interventions (individual-level), integrating PrEP into existing facility-based programs (organizational-level), and de-medicalizing PrEP (policy-level). Dr. Oni Blackstone (Health Justice) discussed on the impact of medical mistrust on HIV service delivery in the US. She discussed how sometimes mistrust can be a positive coping mechanism/survival strategy for historically marginalized populations and how the narratives that drive mistrust should be reframed as counternarratives vs. “conspiracy beliefs”. While there are no evidence-based interventions to address mistrust, some to consider include having providers validate clients’ mistrust and using community-centered practice to build trustworthiness. Dr. William Nutland (PrEPster), a PrEP user, reframed the conversation to “Build it: Will we come?” – emphasizing how PrEP users are an integral part of HIV prevention and should be embedded in PrEP practice, policy, and research. He discussed the importance of engaging PrEP users to proudly talk about PrEP use and offer/deliver PrEP in convenient/appropriate settings, as well as the need for PrEP open access, user control, and conversations surrounding additional benefits of PrEP use (e.g., sexual enjoyment).

With a number of new HIV prevention products in the pipeline (e.g., long-acting injectable cabotegravir), this symposium emphasized the need to work closely with the populations for which these interventions are intended to determine their preferences and design/test models of delivery that address these. Additionally, the symposium discussed the importance increasing access points for prevention interventions (e.g., mobile units, community pharmacies) and creating inclusive policies that work towards de-medicalizing and increasing the affordability of prevention products.