Allison Cole, FHI 360
Emily Donaldson, FHI 360
Casey Bishopp, FHI 360

It’s an exciting time for HIV prevention. New products including PrEP ring and CAB PrEP are making their way into the market, and adolescent girls and young women (AGYW) are poised to have a choice of method for the very first time. Just as the PrEP landscape is rapidly evolving, so too is the world in which young women are coming of age—and our marketing efforts must keep up if we want to remain relevant to our audience. When oral PrEP was introduced, we were disappointed by low demand from AGYW. With the introduction of new products comes an opportunity to do things differently—to take an approach to PrEP marketing and demand generation that 1) understands that young women today are different from young women in the past; 2) uncovers the deep emotional drivers that should influence marketing and demand generation campaigns; and 3) does not reinforce harmful gender norms or stereotypes.

To be effective in generating demand, we need to market PrEP to the young women of today and tomorrow.

Five years ago, we lived in a pre-COVID world—an enormously different place than the world today. Ten years ago, TikTok had not yet made its debut into the social media landscape, and 20 years ago, Facebook had just been founded. World events and social media have dramatically transformed the environment in which young women grow into themselves and interact with the world around them.

Young women today are working hard, recognizing their own strength, and nurturing their well-being. They are surrounded by influencers, artists, and writers who believe in themselves and express themselves boldly. They listen to musicians like Beyonce and Bonang Matheba—women who are “go-getters,” who are fierce, and who are unapologetic about their strength. They are less cautious of others’ expectations or traditional roles.

For the nearly three decades that research on HIV prevention for women has been ongoing, intimate partner relationships have been seen as the central driver of PrEP and HIV prevention method uptake and use.Past research shows the importance of relationships in women’s ability to take up and use HIV prevention products and services and their centrality to women’s health and wellbeing. Because of this research, oral PrEP marketing and demand generation campaigns emphasize these insights and focus heavily on intimate partner relationships, situating women’s PrEP use mainly in that context. These campaigns often portray relationships as single-partner, heterosexual, and male-dominated in both imagery and language.

To understand what drives PrEP use for young women, we need to dig deeper and consider how they feel about PrEP and HIV prevention in the context of their lives and relationships. As MOSAIC worked to develop a brand positioning strategy for the PrEP category for young women, we relied on the NextGen Squad to help us critically assess insights from previous research and ensure we carried forward into the positioning only the insights that truly resonate with today’s young women. We dug into questions such as, “Would emphasizing this insight strengthen the agency of young women as actors in their own lives? Does it inspire and enable young women to create their own vision of positive change in their lives? Does the insight reflect women and girls as rational beings, capable of making an informed choice and asserting their bodily integrity?” Through discussions around these and other critical questions about existing insights, the NGS helped us uncover an important shift in the role that young women’s relationships play in their decisions around PrEP use: romantic relationships remain an important element of young women’s lives, but the world has changed—and so have the impact of influencers on AGYW’s decision to use PrEP.

Through the process of validating our brand positioning strategy with 121 young women in urban, peri-urban, and rural settings in Kenya, South Africa, and Zimbabwe, we heard further confirmation that while young women are often taking PrEP in the context of a romantic relationship, the relationship is not the fundamental driver behind the decision to use PrEP. Instead, feelings of control, the desire for safety, a need for peace of mind, and an emphasis on self-care—meaning caring about yourself enough to have a long and healthy life—are the underlying emotional drivers. 

Focusing on romantic relationships in marketing and demand generation campaigns risks reinforcing harmful gender norms and alienating young women whose lived realities are different. 

Relationships are often emphasized in demand generation campaigns in a way that can serve to reinforce harmful gender norms and dynamics, since marketing HIV prevention to young women only in the context of romantic partnerships can encourage the idea that an AGYW is not her own person, but an extension of her male partner. This approach also serves to alienate young women who are not in a relationship or are in a same-sex relationship. We know that not all intimate partner relationships are the same: young women may be having sex whether they are in a relationship or not; and for some, a sexual relationship may be transactional. Marketing around relationships typically does not take these more nuanced or non-traditional arrangements into consideration, which means members of our intended audience are being left out. We want all young women who could benefit from PrEP to know that PrEP is for them, regardless of their relationship status.

Marketing aimed at young women should seek to understand what emotions drive young women to take up and use PrEP.

Marketing and branding efforts should be built on an understanding of how the consumer feels about a product to inspire behavior change. Positioning, the foundation of any strong brand, is meant to be aspirational and future-focused; it should ultimately guide the development of communication that reflects back to the audience what they believe about themselves. Young women today seek programs, services, and products that acknowledge their inherent strength. For PrEP, this means framing demand generation efforts around showing young women that we believe in them and support them for who they already are.

Young women’s reasons for using PrEP might be to have control of their health, to put their mind at ease in moments of fear, to act on their own self-care, or to support themselves to have a long and healthy life. While all of these can be true in the context of relationships, when we probe further to identify the emotional drivers themselves, we tap into the underlying needs that a young woman has—and give her a reason to believe that PrEP can meet those needs.

Featured Image: Margaret Akinyi Atieno, LVCT Health youth advocate and MOSAIC NextGen Squad member, in Maseru, Lesotho, October 2022 (Aubrey Weber/MOSAIC).