Anthony K J Smith

This session examined challenges but also innovative approaches for engaging different populations with HIV prevention services. These included considering barriers to methadone services and racial inequalities in testing; the acceptability and feasibility of dapivirine vaginal rings; and the potential for different forms of demand creation for engaging youth with PrEP.

Amanda Liberman (Yale University, United States) presented on focus groups with people who inject opioids, and interviews with service directors and policymakers to explore barriers to methadone services. The study identified conditions of program entry, fears about methadone, and lack of access to methadone as barriers, along with stigmatising language from program directors. Malvern Munjoma (Population Solutions for Health, Zimbabwe) presented on a two-arm prospective cohort study examining the acceptability of dapivirine vaginal rings (DVR) with adolescent girls and young women. The study found that DVR was preferred over oral PrEP, had a higher continuation rate, and low seroconversions and side effects were reported. Tham Tran (PATH, Vietnam) presented on multiple ‘edutainment’ strategies in Vietnam to engage young people with PrEP and sexual health. Drawing on fun, visual, and engaging campaigns with social media, school tours, youth ambassadors, and music has contributed to Vietnam’s successful PrEP uptake. Marcus Vinicius França (Universidade do Estado da Bahia, Brazil) analyzed differences in rates of HIV testing across lifetime by race amongst adolescent men who have sex with men and transgender women in Brazil in a PrEP demonstration cohort study. The low testing rate amongst Black adolescent people was evidence of structural racism.

During question time, Munjoma explained that adolescents in rural areas preferred DVR over oral PrEP as it is easier to hide from family. Tran also explained that while the Vietnamese campaign was successful in engaging schools, it required buy-in from school leaders and parents, which was not always successful. Liberman’s study highlighted the need to challenge program directors’ stigmatizing views of people who use drugs to begin addressing other barriers. Overall, this session highlighted that understanding barriers, but also creating demand for services in a variety of ways is important for contextually realising successful HIV prevention and health services.