Testing PrEP for Men for HIV/AIDS Prevention in South Africa

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Anu Khosla

Anu Khosla is a brand strategist and next generation philanthropist who marries analytical thinking and science literacy with empathy-driven decision making to drive social impact. Anu is committed to addressing inequality and strengthening civil society through her work. She currently sits on the ProPublica Business Advisory Council. She holds a BA in Human Biology with a concentration in Global and Public Health from Stanford University and a MPS in Branding from the School of Visual Arts, where she was a recipient of the 2016 Paula Rhodes Memorial Award for Exceptional Achievement in Branding.

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The Issue

In South Africa, 7.1 million people are estimated to be living with HIV, with approximately 231,000 new infections every year.  

Both prevalence and incidence are higher among women than among men, but whereas women’s incidence has dropped by roughly half since 2012, incidence among men has only reduced slightly during that period. Men in their mid-twenties to mid-thirties are particularly vulnerable, with prevalence spiking from only about 5 percent among men 15-24 to almost 25 percent among men 35-39.

Many governments, donors, and implementers involved in the HIV response acknowledge the importance of “reaching” men. Yet, few have been willing or able to invest in understanding from men what they want and need. If we are to succeed in harnessing men’s potential to prevent HIV transmission, we need to understand them, and be willing to challenge long-held assumptions about how health care works.

The effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV has been well established for years, but to date, no PrEP study has focused specifically on heterosexual men. Knowing the risks, many men forego preventive measures for HIV transmission, choosing not to be circumcised and engaging in multiple concurrent sexual partnerships without the use of condoms.

If we can get even a modest segment of these men to use PrEP, we can have a significant impact on preventing HIV acquisition, while also protecting girls and women by making these men safer partners.

Pilot And Learn

This project will use design research methodologies to test and pilot the use of pre-exposure prophylaxis (PrEP) for men, a promising new approach to HIV prevention in which people at high risk for acquiring HIV take a daily pill to prevent infection.

Key questions that we aim to answer include: 

  • Is there a segment of high-risk men who would be willing and able to take PrEP?
  • What are the barriers that we would need to overcome, and what are the drivers that we could leverage, in order to reach these men?
  • Could we develop a service delivery model for PrEP that is acceptable, feasible, scalable, and cost effective?
  • Could key stakeholders in South Africa be persuaded to embrace and champion this model?

Leverage And Scale

Research and potential piloting of PrEP for men is a unique opportunity to develop and contribute cutting-edge insights and evidence that could shape the HIV response for millions of people in South Africa and beyond.

PrEP is a relatively new HIV prevention technology whose potential is still in the early stages of being explored and developed, but which could prove to be a game changer in breaking the cycle of transmission and achieving epidemic control, particularly for certain high-risk segments of the population.