HIVR4P: Integrate Pleasure into HIV Prevention Efforts, Urges Dr. Sarit Golub
By Avit Ndayiziga
At the 5th HIV Research for Prevention Conference (HIVR4P), held in Lima, Peru, from October 6 to 10, 2024, an important call arose to shift HIV prevention efforts away from fear-based approaches and toward ones that prioritise pleasure and empathy. Dr. Sarit Golub, a social psychologist with extensive public health experience, called for the integration of pleasure into HIV prevention efforts.
In a symposium session titled “Reducing Burdens and Barriers to Expand the Use of HIV Prevention Options” and an exclusive interview with Community Voice, Dr. Golub addressed the effects of relying on risk-based language within public health systems, emphasising that fear and judgment are poor long-term motivators for healthy behavior.
Pleasure integration into HIV prevention efforts
Dr. Golub, a Professor of Psychology at Hunter College and the CUNY Graduate Center, used a theory of threat as an example, highlighting that from a 2017 PrEP training, a healthcare provider suggested that PrEP could allow people to engage in unrestricted sexual activity without the risk of HIV. “A tremendous amount of psychology research shows that threat is not a good motivator,” she said. “It might work for a short period, but it soon engenders reactance, which is detrimental to everyone involved.” Instead, Golub suggested that service providers should embrace their role in facilitating sexual expression, rather than reducing the threat of illness but promoting sexual wellness.
Promoting Health Over Fear
Dr. Golub, who also directs the Hunter Alliance for Research and Translation (HART), acknowledges that significant strides have been made in HIV prevention messaging, yet believes much work remains.
“In the early days of the HIV epidemic, public health messaging aimed at encouraging testing was often steeped in shame and fear. Campaigns conveyed messages such as “you can never know” or “you can never trust your partner,” emphasizing alarming statistics like the prediction that one in two Black men in the United States would eventually be infected with HIV. This negative framing has evolved, and while significant progress has been made, the prevailing mindset in public health still heavily focuses on disease prevention rather than health promotion,” Dr. Golub emphasised.
Transforming HIV Prevention: Integrating Psychological and Biomedical Approaches
Recognising the vital role of psychological approaches in HIV prevention—by reducing stigma, improving knowledge about HIV, and promoting positive attitudes toward testing and treatment—Dr. Golub advocates for bridging the gap between biomedical and behavioural prevention, urging that they be viewed as interconnected rather than separate strategies.
According to Dr. Golub, “Every healthcare intervention requires actions from patients, providers, and the broader system.” She cautions that “when we behave in ways that undermine patient trust—like requiring multiple visits, long waits, or failing to offer desired options—misinformation becomes more believable because trust was never built.” Dr. Golub emphasised that it’s the responsibility of providers, researchers, and advocates—not patients—to create a trustworthy and supportive environment.
Fostering a more supportive and empowering atmosphere for patients
According to Dr. Golub, the distance between patients and the broader healthcare system poses significant risks. She emphasised that healthcare providers need to cultivate a more supportive and engaging environment by empathizing with patients’ experiences. “One of our greatest strengths as human beings is our ability to adopt another’s perspective and envision what it might be like to walk in their shoes,” she explained. “In healthcare, we often fall short in this regard. We need to better understand our patients’ experiences and tailor our services to meet them where they are.”
During the same session, Yvette Raphael, a prominent advocate, presented the “Choice Manifesto,” focusing on structural and behavioral approaches to enhance user agency in HIV prevention, especially among African youth. She also presented the experience of the African Women Prevention Community Accountability Board, its advocacy strategies, and achievements.
Meanwhile, Michael Stirratt of the US National Institute of Mental Health focused on combating misinformation in HIV and vaccine contexts. He underscored the importance of tailored communication strategies, positive emotional appeal, and using trusted messengers to improve the uptake of HIV prevention tools.
Adding to this conversation, Rayner Kay Jin Tan from the National University of Singapore examined the role of drugs in sexual behaviors, advocating for a pleasure-centred harm reduction approach to destigmatize drug use in sexual contexts.
