Self-Care Advocacy for HIV and STI Prevention 

What is Self-Care and Why is it Needed to Address HIV and STIs?

Self-care is the ability of people to promote and maintain health, prevent disease, and cope with illness and disability with or without the support of a healthcare worker. Self-care is important as, globally, gaps exist in accessing comprehensive sexual and reproductive health (SRH) care for all. Self-care for the prevention of HIV and sexually transmitted infections (STIs) can be applied through a variety of approaches including self-testing, self-collection, and self-medication.

In 2023, there were 1.3 million new HIV infections—far higher than the target of 370,000 new infections by 2025. STIs account for over 1 million new infections daily and are increasing in many regions, with an estimated 374 million new chlamydia, gonorrhea, syphilis, and trichomoniasis infections annually. Both HIV and STI self-testing and self-collection could help to avert many of these new infections, improving sexual and reproductive health globally. Additionally, user-controlled tools such as the Dual Prevention Pill (DPP) for HIV and pregnancy prevention could be appealing to the millions of people of childbearing potential with an unmet need for contraception who may also want HIV prevention.

Overall, self-care interventions put more control in the hands of people, which can alleviate stressors associated with provider-administered services and enhance access to and quality of care. Self-care options can be more convenient, comfortable, and discreet, which is especially important for key populations and adolescents, who can face heightened stigma and discrimination at health facilities. Self-care also eases the workload burden on providers to deliver every aspect of care. When people can self-collect their own samples or self-inject medicine in a location of their choosing, both the individual and the health system benefit.

Examples of Self-Care Tools

The reproductive health field has successfully introduced a number of self-care interventions to expand SRH care and provide people with more control over their health. The self-injectable contraceptive DMPA-sub-cutaneous (SC)  requires minimal training to self-administer and offers an alternative to the provider-administered contraceptive injectable, DMPA-intramuscular (IM). DMPA-SC was first available for self-injection in 2016, and by 2023, was provided in more than 55 countries, at least 35 of which offer self-injection. Self-testing for pregnancy, use of ovulation predictor kits, and self-managed abortion are other examples of how self-care for reproductive health has become commonplace. Below are a few examples of self-care tools specifically addressing HIV and STIs, with more under development.

HIV Self-Testing
HIV self-testing (HIVST) is a reliable and convenient alternative to provider-administered testing for those who want to learn their HIV status in private. Its use is well-established, having been recommended by the World Health Organization (WHO) since 2016, and it is currently authorized in over 100 countries. Accurate, fast, and affordable oral and blood-based tests are available, including several which have been pre-qualified by the WHO. HIVST offers many opportunities to increase testing uptake, including by expanding testing to people who value discretion, such as key populations and adolescents, as well as those who prefer to access services outside of a traditional facility, as HIVST kits can be distributed from a range of locations including pharmacies, within the community, and online. HIVST is also recommended by WHO for use in initiation and continuation of oral PrEP, the dapivirine vaginal ring, and post-exposure prophylaxis (PEP) as a means to promote further discretion and simplification of PrEP and PEP delivery

Oral PrEP Dosing Options
Oral PrEP is a highly effective method of HIV prevention. For many people, using oral PrEP means taking a pill consistently every day. However, some populations, including people assigned male at birth who are not taking gender-affirming hormones, have the option of “on-demand” or “event-driven” dosing, giving them the flexibility to decide when and how to take oral PrEP. On-demand dosing involves taking two PrEP pills between two and 24 hours before sexual exposure, and one pill daily until two days after the last sexual exposure. This regimen is particularly convenient for those with infrequent exposure to HIV but can also be extended indefinitely into daily oral PrEP if the user finds they want more consistent protection, putting them in control of their PrEP use. Further research is needed to establish optimal on-demand dosing regimens for a wide range of populations, including those assigned female at birth.

STI Self-Collection
Human papillomavirus (HPV) self-collection is one tool used for cervical cancer screening where a person collects a sample from their cervix that is then tested for HPV. This can help to address stigma and reduce discomfort often associated with traditional screening methods by allowing people to collect their own samples in a healthcare setting, their home, or anywhere they feel comfortable. Widespread implementation of HPV self-collection could significantly reduce the incidence of cervical cancer, particularly in underserved communities, by reaching more people and encouraging routine monitoring.

Overall, this is a technique that can be used for many STIs, including chlamydia and gonorrhea. Studies have shown that self-collection is just as accurate as clinician-collected samples, and it has the potential to increase screening rates, particularly among those who may otherwise avoid regular check-ups due to barriers like embarrassment, lack of time, or limited access to healthcare facilities. However, implementation of STI self-collection for testing and screening remains limited and advocacy and education campaigns are needed to improve awareness about this option among both providers and patients.

STI Self-Testing
Currently STI self-tests remain limited but could offer a practical and effective way to detect infections in the absence of or before symptoms appear. In the United States, a syphilis self-test received FDA approval in 2024. In the same year, Australia approved a gonorrhea and chlamydia self-test for people assigned female at birth. The convenience and privacy of self-testing encourage people to check their status more regularly, especially for those who may feel uncomfortable or stigmatized by traditional clinic visits. Furthermore, STI self-testing allows for faster diagnosis and treatment, which is critical in preventing the onward transmission of infections.

Dual Prevention Pill
The DPP is a co-formulated tablet combining oral PrEP and combined oral contraception for the simultaneous prevention of HIV and pregnancy. Cisgender women and girls face persistent high rates of HIV acquisition and unmet need for contraception, yet HIV and Family Planning (FP) healthcare services are often siloed, delivered in different clinics or areas within a clinic by different providers. The DPP, which is currently under regulatory review and could be introduced in 2025, would be the first multi-purpose prevention technology (MPT) available since condoms. While condom use can be difficult to negotiate, the DPP is user-controlled and would afford users greater agency to mediate use. One pill makes the DPP more convenient than separate PrEP and FP products—which could motivate uptake, adherence and continued use, which we have seen are challenges with oral PrEP and oral contraception.

Moreover, the DPP is designed to look and feel more like a contraceptive, with packaging in a blister pack, similar to oral contraception, and pink and peach pill colors that distinguish it from blue-colored PrEP pills. As such, users may opt to disguise the DPP as contraception around those who may be resistant to PrEP, such as romantic partners. Advocating for approval of the DPP at the country level could accelerate introduction of this novel self-care option.

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