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HIV and AIDS remain one of the leading public health challenges in the world, with young women in sub-Saharan Africa bearing the brunt of HIV infection. Female vulnerability to HIV infection is exacerbated by socio-cultural, economic and biological dynamics. Vaginal microbicide, one of the first topical pre-exposure prophylaxis (PrEP) innovations for HIV prevention can offer new hope for women, but an understanding of the local cultural context and its influence on product acceptability is fundamental for effective HIV communication strategies. Critical health communication navigates through the complexities of cultural discourses to create awareness among women in dominant cultural settings. As a means of understanding the key determinants for effective HIV communication, this paper used thematic analysis of data from a study among female students at the University of KwaZulu-Natal regarding their preferences and the acceptability of two microbicide technologies: the tenofovir gel and the dapivirine ring. Keyfindings indicate that microbicides give women more options for self-protection and cater for diverse sexual encounters, and that their covert use empowers women to use the products even if male partners do not support this. However, women felt more empowered with “male-supported, female-initiated” HIV prevention options. The study suggests that in providing HIV preventionoptions to women, culturally appropriate messages must be considered. We suggested that topical PrEP must be communicated as a “male-supported, female-initiated” HIV prevention option in rural KwaZulu-Natal contexts.

Oral PrEP promotion is a key aspect of combination prevention efforts to increase opportunities for HIV prevention among adolescent girls and young women (AGYW) who are at higher risk of infection. Research suggests that communication efforts often adopt an individualistic decision-making approach that is devoid of the multiple influences that impact young women’s HIV preventative choices. Schools and educators are increasingly being identified as key role players and influencers of decision making among young women. The promotion of PrEP uptake among AGYW of school going age, thus requires an exploration of perceptions of educators about the related benefits and barriers to PrEP uptake among school girls. A qualitative study using a purposive sampling method was used to sample 6 high schools in Vulindlela, a district with the highest HIV incidents among AGYW in KwaZulu-Natal. Semi-structured interviews were conducted with a total of twelve Life Orientation educators and senior staff members from the 6 selected high schools. The data was transcribed and analysed thematically using the culture-centred approach. The findings suggested that educators acknowledged the benefits of PrEP in curbing HIV infection rates among young women. However, these benefits were clouded by barriers and concerns around minimal, or poor condom use as a result of oral PrEP use which could promote promiscuity and minimalise efficacy. These findings highlight the need for more contextual community-driven communication strategies around PrEP, and emphasise the value of a community-centred approach that promotes dialogue among key role players, like educators, to further enhance PrEP communication.

The HIV response in the African continent over past decades demonstrates the potency that the words and actions of political leaders have in either expediting or impeding the implementation and adoption of preventive measures at the individual and community levels. The article explores the health communication approaches employed by two South African past presidents (Thabo Mbeki and Jacob Zuma) in responding to the HIV epidemic, and contrasts these with the communicative approach of President Cyril Ramaphosa during the COVID-19 pandemic. Approached from this understanding, this article provides a comparative analysis of the communication approaches of these three presidencies across the two pandemics, and considers the variously trusted sources of top-down, government-driven and bottom-up, community-informed approaches to health communication. Critical lessons that emerged in South Africa during the HIV epidemic regarding the need to include communities in communicating about risks and behaviour change have not been adopted into the COVID-19 response. Political leaders are not best placed to communicate about these issues, and, in the context of pandemics, there is a clear need to reconsider top-down communication approaches that are designed without the participation of communities and ignore the interconnected nature of health and other social determinants of health.