The research team, led by Gloria Aidoo-Frimpong of the University at Buffalo in collaboration with Ghanaian colleagues from institutions including Ensign Global University and hospitals in Osiem and Offinso, brought together ten adolescent girls and young women and five community interest-holders for an intensive co-creation workshop. The methodological architecture of the study reflected a deliberate commitment to participatory design. Rather than extracting survey responses and departing, the investigators audio-recorded group discussions, captured facilitator field notes, and employed the Nominal Group Technique, a structured consensus method in which participants independently generate and rank ideas before the group deliberates. This ranking procedure allowed the researchers to quantify which barriers participants considered most pressing, while the open discussions and intervention prototypes revealed the texture and reasoning behind those priorities. Transcripts were then subjected to thematic analysis with iterative coding and consensus refinement, a process in which coders repeatedly revisited the data until the interpretive categories stabilized.

What emerged from the analysis was a four-tier map of obstacles operating at distinct but interlocking levels. The first and arguably most pervasive domain involved cultural and religious norms that moralized female sexuality. Participants described how conversations about HIV prevention were frequently framed as evidence of inappropriate behavior, so that a young woman seeking an HIV test or requesting PrEP risked being read as sexually active, and therefore as transgressing expectations of feminine propriety. This moral framing transformed a straightforward health behavior into a social gamble. The second domain concerned knowledge that was real but not actionable. Many participants had heard of HIV self-testing and PrEP, yet they lacked procedural clarity about how the tests worked, how PrEP should be taken, and what to do with a result, leaving them uncertain at precisely the moments when confidence mattered most.

The third barrier domain was emotional and relational. Fear and stigma did not operate only through overt discrimination; they worked through anticipatory distress, the dread of what might happen if a test were discovered, and through relational scrutiny, the sense that partners, family members, or neighbors were constantly evaluating a young woman’s choices. Confidentiality concerns compounded this anxiety, because participants worried that clinic staff or visible service points could expose their prevention activities to their communities. The fourth domain was structural: inconsistent availability of services meant that even motivated women could not count on finding supplies, financial barriers put testing kits and clinic visits out of reach for some, geographic inequities concentrated resources in places easier for urban than rural women to access, and health system practices themselves sometimes deterred rather than welcomed young clients.

The analytical insight of the study lies in how these domains interact. A young woman might possess accurate knowledge about PrEP, for example, but cultural norms that moralize female sexuality could make it socially costly to visit a clinic, while financial constraints and unreliable stock could render the trip futile even if she overcame her hesitation. Conversely, a well-stocked facility in her neighborhood would not help if she feared being seen entering it. The researchers mapped each barrier to the level at which it manifested, individual, interpersonal, socio-cultural, or structural, and then aligned the co-created strategies to those manifestations. This multilevel mapping matters for implementation science because interventions that address only one layer tend to be overwhelmed by the others. A peer education program, however well designed, will struggle if the nearest clinic has no PrEP in stock or if faith leaders publicly condemn its use.

The strategies that participants designed were strikingly concrete and culturally embedded. Storytelling emerged as a central vehicle: narratives grounded in local experience could carry prevention information in forms that felt legitimate rather than clinical, allowing sensitive topics to be discussed without triggering the moral judgments that direct messaging provoked. Participants also proposed deliberate engagement with faith leaders, recognizing that religious authorities shape the very norms that moralize female sexuality, and that their endorsement could either unlock or foreclose community acceptance of HIV prevention services. Rather than treating religion as an obstacle to be circumvented, the young women positioned faith communities as potential allies whose involvement could reframe prevention as responsible and respectable behavior.

Digital tools featured prominently in the co-designed package, but with an attention to developmental nuance that top-down programs often miss. Participants envisioned peer-led education delivered through WhatsApp, the messaging platform that dominates social communication in Ghana, with content tailored to different stages of adolescence and young adulthood. The rationale was that a fourteen-year-old girl navigating school and family supervision has different prevention needs, relationship contexts, and communication preferences than a twenty-two-year-old woman in a partnership or running her own household. A single undifferentiated message, the participants argued, would speak to neither. Alongside the peer-led channels, they proposed anonymous digital support mechanisms that would allow young women to ask questions and seek reassurance without revealing their identities, directly targeting the confidentiality fears that the analysis had identified as a core barrier.

The final strand of the co-designed strategy addressed the structural layer through decentralized, community-based service delivery. By moving HIV self-testing kits and PrEP access out of centralized facilities and into community settings, the participants aimed to reduce the geographic and financial costs of prevention while shrinking the visibility that made clinic visits socially risky. The emphasis on decentralization reflects a broader recognition in health services research that access is not merely a matter of distance but of the total burden, in time, money, and social exposure, that a service imposes on its user. For young women whose mobility and spending money may be controlled by others, a service that requires a long, conspicuous journey is effectively unavailable regardless of its official existence.

The WISE WOMAN findings now set the stage for a pilot phase intended to evaluate the feasibility and acceptability of the co-created strategies and to refine them for broader scale-up. The study’s authors emphasize that grounding intervention design in lived experience and structural reality offers contextually specific guidance that imported models cannot supply, and the ethical architecture of the work, approved by the University at Buffalo’s Institutional Review Board and Ensign Global College’s ethics committee and conducted in accordance with the Declaration of Helsinki and Ghana’s Data Protection Act, underscores the care taken with a vulnerable population. The research was funded through the University at Buffalo’s global research seed funding program, with the funders having no role in the design or interpretation. Whether storytelling circles, faith-leader partnerships, WhatsApp peer networks, and community distribution points can measurably raise testing and PrEP uptake remains to be demonstrated, but the study makes a compelling methodological claim: the young women closest to the problem are also the most precise diagnosticians of it, and interventions that begin with their analysis stand a far better chance of surviving contact with the communities they aim to serve.

Subject of Research: Women-centered co-design of HIV self-testing and PrEP implementation strategies for adolescent girls and young women in Ghana

Article Title: Co-developing women-centered strategies to improve HIV self-testing and PrEP uptake among adolescent girls and young women in Ghana: Findings from the WISE WOMAN study

Article References: Aidoo-Frimpong, G., Mensah, W. K., Anyidoho, D. S., Obeng, Y. A., Abubakar, A. T., & Oduro, M. A. (2026). Co-developing women-centered strategies to improve HIV self-testing and PrEP uptake among adolescent girls and young women in Ghana: Findings from the WISE WOMAN study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15750-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15750-1

Keywords: HIV self-testing, PrEP, adolescent girls and young women, Ghana, participatory research, implementation science, human-centered design, nominal group technique, HIV stigma, women's health, community-based services, sub-Saharan Africa

The study, led by Hong-Van Tieu of the New York Blood Center and Columbia University Irving Medical Center together with Beryl Koblin, Anne M. Teitelman, and colleagues in New York City and Philadelphia, enrolled 83 cisgender women aged 18 to 55 who were not living with HIV, were not currently taking PrEP, and met established clinical eligibility guidelines for the medication. The participants were randomized in a 3:1 ratio, with 61 women assigned to the full Just4Us Education and Activities arm and 22 women assigned to an Information-only comparison arm. Both groups received PrEP information and a referral list of local providers, but the intervention arm received a far more intensive, personalized package of support designed to move women from awareness to actual initiation and sustained use of PrEP.

The Just4Us intervention is grounded in behavioral theory and shaped directly by formative research with women at elevated risk for HIV. At its core is an individually delivered session with a counselor-navigator—a trained professional who combines the roles of health educator and care coordinator. During the session, the counselor-navigator provides detailed information about PrEP, works through motivation enhancement exercises, builds practical skills for negotiating prevention with partners and navigating the health care system, engages in collaborative problem-solving around barriers such as cost, transportation, and stigma, and makes concrete referrals to PrEP-prescribing clinics. The session incorporates tablet-based activities and a video, giving participants interactive ways to engage with the material rather than passively receiving it.

What distinguishes Just4Us from many one-off counseling interventions is the support that continues after the initial session. Between baseline and the three-month follow-up, women in the intervention arm received telephone calls from their counselor-navigator to support linkage to PrEP care, along with text messages designed to promote adherence for those who started the medication. This two-pronged follow-up strategy reflects a growing recognition in implementation science that the moment a woman decides to try PrEP is often the moment she encounters the greatest logistical obstacles—insurance paperwork, clinic wait times, lab appointments—and that sustained, low-burden contact can keep her moving forward.

The feasibility results were striking. The attendance rate for the initial session was 100 percent in both arms, meaning every single enrolled woman showed up for her assigned intervention. Retention at three months was 90 percent, an exceptionally high figure for a population of socially disadvantaged women who often face competing demands on their time and unstable access to health care. The research team also exceeded its diversity and enrollment targets: 79 percent of participants were Black and 26 percent were Latina, ensuring that the intervention was tested among the very communities that bear a disproportionate share of new HIV infections among women in the United States.

Acceptability data were equally encouraging. Among women in the intervention arm, 95 percent reported feeling very satisfied or satisfied with the overall session, and 97 percent expressed satisfaction with their discussion with the counselor-navigator. The tablet activities earned a 95 percent satisfaction rating, the text-messaging setup 93 percent, and the video 90 percent. Across both arms, 78 percent of participants felt the session length was just right, and an overwhelming 95 percent said they would recommend or strongly recommend Just4Us to others. These numbers matter because acceptability is often the Achilles’ heel of behavioral interventions: a program can be clinically effective on paper but fail in the real world if participants find it burdensome, judgmental, or irrelevant to their lives.

The success of Just4Us is best understood against the backdrop of persistent barriers that keep women away from PrEP. Previous work by the same research team, including a theory-informed elicitation study published in AIDS Care, identified individual, social, and structural factors that shape PrEP uptake among cisgender women, including limited awareness, concerns about side effects, mistrust of the medical system, and the dual burdens of PrEP stigma and HIV stigma. Research published in Stigma and Health by the team found that both PrEP-specific and HIV-related stigma were associated with lower intention to use PrEP among women in New York City and Philadelphia. A woman may worry that seeking PrEP will lead others to assume she is HIV-positive or sexually promiscuous, a concern that has no direct parallel in many other prevention contexts and that demands an intervention tailored specifically to women’s social realities.

The trial also arrives at a moment of rapid expansion in biomedical HIV prevention options. In 2024, the U.S. Food and Drug Administration approved the first injectable treatment for HIV pre-exposure prevention, and the PURPOSE 1 trial reported in the New England Journal of Medicine that twice-yearly lenacapavir provided striking protection for cisgender women. The HPTN 084 trial had already demonstrated the efficacy of long-acting cabotegravir in women, and the DELIVER study established the safety of the dapivirine vaginal ring and oral PrEP during pregnancy. Yet these advances only translate into public health impact if women at risk actually access the tools, which makes behavioral interventions like Just4Us—the connective tissue between biomedical products and the people who need them—more important than ever. The Centers for Disease Control and Prevention has emphasized expanding PrEP coverage as a cornerstone of the Ending the HIV Epidemic initiative, and implementation research on pharmacist-led services, nurse-led clinics, and integration into obstetrics and gynecology settings all points to the same conclusion: delivery models must meet women where they are.

The Just4Us study team was able to recruit the target number of PrEP-eligible women, implement the interventions with a high degree of fidelity, and retain participants through follow-up, all of which are essential prerequisites for a larger efficacy trial. The pilot’s design, funded by the National Institute of Mental Health through an intervention development grant, reflects a deliberate staged approach: first demonstrate that the intervention can be delivered as intended and embraced by participants, then test whether it actually increases PrEP initiation and adherence compared with standard information provision. The high satisfaction ratings and near-perfect attendance suggest that the counselor-navigator model, the interactive tablet activities, and the text-message support struck a chord with women who have historically been underserved by HIV prevention systems.

Limitations remain, as they do in any pilot study. The trial was small, conducted in two East Coast cities, and not powered to detect differences in PrEP uptake between arms; the 3:1 randomization prioritized refining the intervention over hypothesis testing. The published report does not provide outcome data on how many women in each arm ultimately initiated PrEP, which will be the critical question for future efficacy research. Still, the findings offer a concrete template for what woman-centered PrEP support can look like: a trusted navigator, culturally attuned content, flexible digital tools, and sustained follow-up that treats linkage to care and adherence as ongoing processes rather than single events. As longer-acting prevention options broaden the menu of choices, interventions like Just4Us will be essential to ensure that women—especially Black and Latina women, who have borne the heaviest burden of a prevention gap—are not left behind in the next chapter of the HIV epidemic.

Subject of Research: A woman-focused behavioral intervention to promote PrEP uptake and adherence among cisgender women at risk for HIV

Article Title: Just4Us: Acceptability and Feasibility of a Woman-Focused Pre-exposure Prophylaxis (PrEP) Randomized Controlled Trial Intervention

Article References: Tieu, H.-V., Koblin, B., Nandi, V., Davis, A., Phan, A., Fiore, D., Teitelman, A. M., & The Just4Us Study Team (2026). Just4Us: Acceptability and Feasibility of a Woman-Focused Pre-exposure Prophylaxis (PrEP) Randomized Controlled Trial Intervention. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03524-z

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03524-z

Keywords: HIV prevention, pre-exposure prophylaxis, PrEP, women's health, randomized controlled trial, counselor-navigator, health disparities, behavioral intervention, Black women, Latina women, text messaging, HIV stigma

The study, conducted by researchers affiliated with Moffitt Cancer Center in collaboration with CAN Community Health, a Ryan White-funded clinic network predominantly based in Florida, was published in the journal Cancer Causes & Control. It set out to identify the sociodemographic, health, and social predictors of anal and cervical cancer screening uptake among adults with and without HIV. The stakes are considerable: high-risk HPV causes more than ninety percent of anal and cervical cancers, and people with HIV are roughly seventeen times more likely to develop anal cancer than people without the virus, while women with HIV face about a fourfold increase in cervical cancer risk. HIV-related immunosuppression allows HPV infection to persist and progress more readily toward malignancy, and health system barriers contribute to later-stage diagnoses and higher mortality among this population.

Both anal and cervical cancers are unusual among malignancies in that they progress through well-defined, detectable precancerous lesions. Removing high-grade squamous intraepithelial lesions can halt progression before invasive cancer develops, which makes screening an unusually powerful prevention tool. For cervical cancer, established guidelines exist: the U.S. Preventive Services Task Force recommends screening every three years for women without HIV aged 21 to 65, while the Infectious Diseases Society of America advises annual screening for women with HIV beginning at age 21. Anal cancer screening guidance is more recent. The landmark ANCHOR study showed that treating anal high-grade lesions in people with HIV significantly reduced anal cancer incidence compared with active monitoring, and those findings underpin the International Anal Neoplasia Society consensus guidelines, which recommend screening for HIV-positive men who have sex with men and transgender women aged 35 and older, and for HIV-negative people in high-risk groups aged 45 and older.

To measure how these recommendations translate into real-world care, the research team implemented a cross-sectional survey between April and June 2024 among adult patients of the CAN clinic network, which serves more than 31,100 unique patients annually, a population that is 35 percent White, 35 percent Black, and 18 percent Hispanic or Latino. The questionnaire, distributed anonymously through the clinic’s electronic patient intake system and offered in English and Spanish, collected information on demographics, health history, cancer prevention behaviors, experiences with the health system, and social exposures including HIV-related stigma. Participants received a twenty-five dollar gift card. From the responses, 412 participants were eligible for anal cancer screening and 294 women were eligible for cervical cancer screening based on current guidelines.

The characteristics of the two screening-eligible groups reflected the populations most at risk. Among those eligible for anal cancer screening, the median age was 56 years, 88.8 percent were living with HIV, and 82.3 percent were men, with roughly two-thirds identifying as gay or lesbian. Among women eligible for cervical cancer screening, the median age was 38 and 43.5 percent were living with HIV. The researchers computed adjusted prevalence ratios using multivariable Poisson regression, guided by the Andersen Behavioral Model of health services use, with models stratified by HIV status and sex to account for documented differences in cancer risk and screening outcomes across these subpopulations.

The anal cancer findings delivered a cautiously optimistic signal. Overall, 58.6 percent of screening-eligible participants reported ever having been screened, most commonly through an anal Pap test or high-resolution anoscopy. After statistical adjustment, men with HIV were 57 percent more likely to have received anal cancer screening than men without HIV. Within the group of men with HIV, uptake was higher among those who had been diagnosed with any precancer and those living with three or more comorbidities, a pattern the authors attribute to more frequent medical encounters creating more opportunities for preventive services. Living in a household of three or more people was associated with significantly lower uptake among these men, possibly reflecting caregiving responsibilities, competing demands, or limited economic means that crowd out preventive visits.

The cervical cancer picture was far less reassuring. Only 47 percent of women with HIV had received guideline-adherent cervical screening, compared with 71 percent of women without HIV, a gap that persisted after adjustment, leaving women with HIV 40 percent less likely to be screened on time. This shortfall is particularly troubling because U.S. guidelines call for more frequent, annual screening in this higher-risk group, not less. The study also identified a psychosocial driver: among women with HIV, greater concerns about disclosing their HIV status were independently associated with lower guideline-adherent cervical screening uptake. This finding reinforces a growing body of evidence that stigma is not merely an abstract social burden but a concrete mechanism that undermines preventive care, engagement with health services, and trust in medical systems.

The researchers point to several practical implications. Community-based, culturally sensitive screening programs embedded in clinics that patients already trust appear to pay dividends, and the integrated social services offered by Ryan White-funded networks may help explain why anal cancer screening among men with HIV exceeded that of their HIV-negative counterparts. For cervical cancer, proven strategies exist to close the gap, including provider reminders, patient education campaigns, and HPV self-collection kits that can overcome geographic barriers, limited access, and the discomfort or stigma associated with pelvic examinations. The authors also note that clinician awareness matters, since gaps in provider knowledge and training about screening recommendations for people with HIV remain documented barriers alongside fragmented care, unstable housing, and transportation difficulties.

The study carries limitations worth noting. It was conducted within a single, highly diverse clinic network in Florida, so results may not generalize everywhere; it captured only patient-reported characteristics rather than provider-level factors; it assessed Pap testing rather than high-risk HPV testing for cervical screening adherence; and its cross-sectional design precludes conclusions about cause and effect, including the timing of precancer diagnoses relative to screening. Small sample sizes in some stratified models may also have limited statistical power. Still, the divergent findings, with anal screening lagging among women even as it advances among men, and cervical screening falling short precisely among the women who need it most, offer clinicians and public health planners a specific map of where targeted interventions, from stigma reduction to self-sampling, could save lives among one of the nation’s most cancer-vulnerable populations.

Subject of Research: Predictors of anal and cervical cancer screening uptake among adults with and without HIV

Article Title: Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network

Article References: Lin, Y. C., Hume, E., Boxtha, C., Commaroto, S. A., Lael, M., Christy, S. M., Vadaparampil, S. T., Giuliano, A. R., Coghill, A. E., Schabath, M. B., Vidrine, D. J., Peterson, J., DiPalmo, S., Joshi, H., Shukla, P., Vidrine, J. I., & Islam, J. Y. (2026). Predictors of anal and cervical cancer screening uptake among adults with and without HIV: survey of a community-based health clinic network. Cancer Causes & Control, 37(10), Article 159. https://doi.org/10.1007/s10552-026-02239-9

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02239-9

Keywords: HIV, anal cancer screening, cervical cancer screening, HPV, cancer prevention, health disparities, HIV stigma, Pap test, community health clinics, guideline adherence, Cancer Causes & Control, Ryan White clinics