As an HIV tester and counselor during my university days and beyond, I learned very quickly that most people have more pressing issues to deal with in their lives than HIV prevention. At at Oberlin College, I often saw clients shortly after an unprotected sexual encounter. For most, condom use to protect against HIV and other STIs had to be negotiated alongside myriad influential experiences and other barriers – including insecurity around the sexual relationship, fear around the sexual encounter, school stress, mental illness, and financial hardship, just to name a few. The very fact that these clients had proactively sought out an HIV test, demonstrated to me that they were both aware of and concerned about HIV risk, but that the prevention methods available to them just did not meet their needs or circumstances.
I noticed similar themes when I worked serving a more diverse urban population as part of a research study on HIV risk behavior after college. For so many, their efforts around HIV prevention were in competition with other critical life challenges like job insecurity, homelessness, incarceration, and intimate partner violence. I’ll never forget one of my first clients who walked into the interview room in a daze, slumping into the chair across from me. Midway through responding to my first question, she dozed off. After offering her water and a snack, she told me she was diabetic, had run out of medication, and hadn’t eaten anything that day. Like this client, I saw many people at high risk of HIV acquisition also faced great adversity in other aspects of their lives – sometimes even struggling to meet their basic needs.
The systemic inequities I witnessed as an HIV tester and counselor are complex to address, particularly from an HIV prevention perspective. But at the very least, we as health professionals need to ensure that HIV prevention tools are not only safe and effective, but easily fit into the lives of the people who need them most. It’s easy to see why I felt that in many of these moments, we were failing.
Then, five years ago, I joined the IMPT Secretariat team and saw the promise of multipurpose prevention technologies (MPTs). MPTs could make life a little easier by combining HIV prevention with contraception or non-HIV STI prevention into a single product. But what really excited me about the MPT field was the interdisciplinary advocacy around changing the paradigm of product development in sexual and reproductive health so that products are designed with the user in mind from the earliest stages. In such a nascent field, it seemed like there was enormous potential to create a completely new and innovative suite of products that were desirable, accessible, and easy to use.
The IMPT has been a leader in advocating for this paradigm shift and developing resources and tools to help move the field in the right direction. From outlining end-user research activities across a typical clinical product development timeline, to identifying and characterizing market-based product development targets, to developing funder evaluation standards for integrating end-user research into HIV prevention R&D, the IMPT works hard to foster and support a field-wide commitment to placing women most in need of comprehensive prevention at the center of MPT development.
This month, I left my position at the IMPT Secretariat to attend to medical school. Eventually, I aim to continue my work combatting the global HIV epidemic as an infectious disease specialist. I hope that my future patients will have better, more innovative prevention tools like MPTs at their disposal than during my HIV testing and counseling days. Shaped by my work with the IMPT Secretariat and inspired by the tenacity and dedication of the IMPT network members, I will continue to advocate for MPTs to improve the lives of women and their families worldwide.