Empowering Women to Prevent HIV

Thandie sat on the edge of her bed. In her spare, tin-covered one-room home, she had a little TV set, clothes drying on hangers, some lotion and a hand mirror. She shared photos of her toddler son. And she told us things that she could not tell her boyfriend: that she didn’t want to get pregnant; that she was worried about getting HIV. But asking her boyfriend to use a condom could make him suspect she was cheating—a dangerous thing for Thandie, whose boyfriend’s anger could boil into abuse.

Today, women make up more than half of people living with HIV worldwide. Social and economic vulnerabilities make young women twice as likely as males their age to acquire HIV.

Understanding this, CONRAD, a global non-profit specializing in women’s reproductive health, has been working for well over a decade developing microbicides—products women can use to protect themselves against HIV infection. As a scientific research institution, CONRAD develops state-of-the-art microbicides, which can be highly effective in preventing HIV infection. However, early clinical trials found that a large percentage of women were not using microbicides. The low uptake was caused in part by the complexity of the drug regimen and the need to develop a new habit, but more significantly by the stigma of HIV itself. Even though the purpose was prevention, the mere association of the microbicide with HIV was enough to generate avoidance and resistance. Women chose to distance themselves from stigma rather than protect themselves.

To bridge the gap between the promise of a women-controlled HIV prevention product and the disappointing initial clinical trial results, USAID issued a call for proposals that ultimately resulted in the Microbicide Product Introduction Initiative (MPii)—five interconnected projects designed to accelerate the introduction of antiretroviral-based HIV prevention products. The call included a challenge: how can uptake and adherence to new microbicide products achieve maximum public health impact by drawing on partners in alternative sectors, including human-centered design?

Recognizing the need to try something different, and curious about the potential of private sector approaches, CONRAD came to IDEO with a question: how can design create an experience that makes women want to use HIV prevention products like microbicides?

Under the joint moniker Project EMOTION, CONRAD and IDEO successfully received funding through USAID, in conjunction with other consortium partners. Together, the team embarked on a multi-year effort to design and test a radically new approach to increasing demand for and adherence to HIV prevention.

To ensure the work was human-centered, the collaboration began with extensive fieldwork in high-risk areas across South Africa. Alongside local research firm Instant Grass, IDEO visited clinics and people’s homes, and held salons and group picnics. The team talked to young and older women, mothers, couples, and male partners. The team learned that while women wanted to protect themselves, they avoided clinics and anything that appeared associated with medical care for fear of the stigma of being seen as sick. Echoing Thandie’s experience, some of the most high-risk women feared a backlash from their partners and felt unable to protect themselves without risking personal harm.

Taking the lessons learned from prototyping, IDEO set out to design and build a complete ecosystem to support a woman’s prevention journey, from hearing about the product to getting an initial HIV test to adopting the regimen long term. The bold brand design was paired with an aspirational and unexpected message to women: instead of “Don’t Get HIV,” this brand says, “Empower Yourself.” The new brand, called V, encourages HIV prevention to be as everyday and acceptable as any self-care practice.

To communicate this new self-care opportunity, IDEO designed a multi-layered marketing strategy, including print and social media campaigns, promotional materials and price-anchoring, with positioning in private sector clinics and pharmacies. The strategy also leveraged South Africa’s deeply rooted concept of ubuntu—the notion of human connectedness—to spread the word about V, empowering brand ambassadors to share the product with their own communities.

The actual prevention medicine—delivered in pill form—is introduced to women in a stylish starter kit, designed to let them be as discreet as they choose. In crowded households, often a woman’s only private space is her purse, so the pill bottle comes nestled in a brightly printed, double-sided makeup bag, along with colorful stickers that can be used to disguise the medical label. In order to eliminate the stigmatizing sound of rattling pills, the kit contains a silicone-lined compartment that looks like a lip balm, but quietly holds a week’s worth of medication.

The vibrant, aspirational brand identity and starter kit tested extremely well with women, promising to be at once attractive and subtle, to eliminate associations with medicine and illness, and to enable women to take charge of their own health. The final hurdle was adherence—how to keep women refilling and using the product regularly. IDEO leveraged the power of community, rallying ambassadors to host gatherings and pair women into buddy systems to support and hold one another accountable. They also created an SMS reminder system to offer a more direct nudge, and a loyalty card.

Building on the insights and feedback from the field, IDEO prototyped two design directions for microbicide regimens—one that appeared hygienic and clean, like a wellness product; and the other designed to feel playful and bright, more like a makeup brand and less like medicine. The team took a road trip across South Africa in a van designed to represent both concepts, with a mission to discover which would resonate more.

Paradoxically, it turned out that the best way to be discrete about HIV prevention was to be visually bold, embracing the aesthetic of an everyday fashion accessory or cosmetic. By creating a brand image that was fun, full of energy, and empowering, the product became largely invisible to men, but desirable to women.

In order to maximize the impact, USAID has open-sourced all the design assets as well as an implementation guide for any organization seeking to increase uptake and adherence in microbicides. You can access the V “brand-in-a-box” at PrEPWatch or through CONRAD's website.

The contents in this article are those of the authors and do not necessarily reflect the view of the U.S. President's Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.