Mwiya Mutandi, FHI 360
Chileshe Bwalya, FHI 360
Mercy Luwi Katoka, FHI 360

Zambia stands at the forefront of a groundbreaking journey in HIV prevention. With its recent accomplishment of being the first country outside the U.S. to administer injectable cabotegravir (CAB PrEP), a long-acting form of pre-exposure prophylaxis (PrEP), Zambia reaffirms its commitment to advancing access to HIV prevention technologies. However, the successful rollout of such innovations goes beyond product availability. It also involves dismantling the structural barriers that hinder access and uptake—chief among them is stigma. Stigma can be a powerful force that affects various aspects of our lives, including our choices around sexual health. At the heart of Zambia’s PrEP rollout efforts are the enthusiastic voices of the MOSAIC Zambia youth network, a vibrant community dedicated to amplifying HIV prevention messages and challenging societal norms that contribute to stigma.  Their involvement underscores the importance of community-led initiatives in transforming public perception and empowering individuals through knowledge and support.

UNDERSTANDING STIGMA AND PrEP

Stigma arises from societal attitudes and misconceptions about HIV, sex, and drug use. PrEP, which involves taking medication to prevent HIV, can sometimes be stigmatized due to misconceptions that it is only for specific “high-risk” groups or that its use implies promiscuity, especially for adolescent girls and young women.

Societal stigma associated with PrEP is real and pervasive. Its impact is so great that individuals may avoid health care because they expect stigma (anticipated stigma), suspect stigma even when it may not exist (perceived stigma), or hold their own stigmatizing opinions about PrEP use (internalized stigma).

Stigma surrounding PrEP creates immense hurdles for marginalized communities seeking HIV prevention. As a disability youth advocate, I’ve witnessed how this stigma deters individuals, especially young women with disabilities, from accessing vital health care. Discriminatory behavior by health care providers perpetuates self-doubt and keeps people away from facilities, depriving them of accurate information and necessary care. To improve PrEP utilization, we must challenge these misconceptions and implement robust education programs. Reducing stigma is pivotal in ensuring equitable access to PrEP, empowering individuals to prioritize their sexual health without fear or shame.

Luke Chingumbe, disability advocate, MOSAIC Zambia Youth Network member 

BREAKING DOWN STIGMA’S IMPACT

REFRAMING PrEP AS EMPOWERMENT

PrEP is a game-changing approach to HIV prevention with the potential to empower individuals to take control of their sexual health and protect themselves from HIV acquisition. By reframing PrEP in this way, we can shift the narrative around HIV prevention from a focus on risk and vulnerability to one of agency and empowerment and begin dismantling PrEP-related stigma in the process.

MOSAIC’s PrEP Category Positioning Strategy for Adolescent Girls and Young Women highlights the process of and learnings about reframing PrEP. Reframing PrEP as empowerment recognizes the inherent agency individuals have in taking control of their sexual health. It also highlights the importance of addressing stigma and other societal barriers to ensure equitable access and utilization of PrEP for all individuals who could benefit from it. Reframing PrEP as empowerment means:

• Taking control of health: Empowerment involves making informed decisions for one’s well-being. Emphasize that choosing PrEP is a proactive step toward safeguarding one’s health.
• Challenging negative norms: Discussing the challenges of negative cultural and gender norms around sex, relationships, and health can be empowering. Address how PrEP users are actively breaking down these norms.
• Reducing risk and anxiety: Highlight that PrEP provides a sense of security and control, reducing anxiety about HIV transmission and allowing for more confident and fulfilling sexual experiences.
• Reframing how we conduct PrEP marketing: Change how PrEP is marketed by moving away from campaign messages that stigmatize HIV and HIV prevention methods, especially among adolescent girls and young women. Analyze PrEP campaigns and marketing strategies through a gender transformative lens.

Embracing PrEP among AGYW is transformative. Abi and Tracey, representing our community, illustrate this empowerment. Abi initially found the daily oral PrEP regimen challenging but persisted, understanding its proactive shield against HIV. Tracey, a year into PrEP, celebrates newfound control over her health … emphasizing the mental relief it provides, in addition to physical protection. Their journeys echo a broader narrative: PrEP isn’t merely a pill or injection; it symbolizes proactive empowerment in sexual health. It has catalysed dialogues, diminished stigma, and inspired advocacy for accessibility within our community, driving modern health care frontiers.

Mable Mweemba, psychosocial counsellor, MOSAIC Zambia Youth Network member 

ENDING STIGMA TOGETHER

As peers, educators, advocates, service providers, family members, and friends, we must emphasize that change starts with awareness and understanding. Through education and advocacy, we can encourage people to challenge their own attitudes and be supportive allies in reducing the stigma around PrEP.

Overcoming the stigma around PrEP is essential to enabling individuals to make informed decisions about their sexual health. By reframing PrEP as an empowering choice, we can break down barriers, increase awareness, and create a more accepting and informed society.

As someone who has personally experienced the impact of HIV infection, I believe in the transformative power of PrEP. Sharing my journey isn’t just about my story; it’s about emphasizing the crucial role PrEP plays in preventing new HIV cases in my community. The innovation in prevention methods, like the new [injectable] CAB PrEP, assures confidentiality and offers long-term protection. Taking responsibility for prevention isn’t just about oneself. It’s about securing peace of mind for oneself and loved ones. It’s about actively participating in ending the spread of HIV. By embracing PrEP, we can change the narrative, empower ourselves, and collectively move towards a future free from stigma and new infections.

Musamba Kaluba, HIV ACTIVIST & COUNSELOR, MOSAIC Zambia Youth Network member 

Featured Image: MOSAIC Zambia staff and members of the PrEP Task Force celebrate the launch of CAB PrEP in Chibombo, Zambia (MOSAIC).