Starting with People, Not Products
Sometimes the biggest product failures aren’t about science or engineering at all. Think of Google Glass or the Amazon Fire Phone: both high-tech, well-resourced innovations that worked as designed, but never caught on. Why? Because people didn’t actually want to use them. They didn’t feel natural, comfortable, or necessary in daily life.
The same risk exists in health innovation. A product can be clinically brilliant and still fail if it doesn’t align with the routines, preferences, and realities of the people it’s meant to serve. At Eidos, we’ve learned that advancing LGBTQ+ health equity requires more than good intentions and promising science. It requires asking the right questions early about how real people interact with the health products and services we’re developing.
That lesson came home to me years ago while listening to a young gay man participating in one of the HIV prevention studies I was working on at the time. He described how the product technically “worked,” but didn’t fit into his daily routine. It wasn’t that he doubted the science. He simply couldn’t see himself using it consistently. That moment underscored something vital: clinical efficacy is necessary, but not sufficient.
Why This Matters for Biotech and Pharma
For biotech and pharmaceutical companies, these insights are not just academic. Products optimized only for pharmacology (how a drug works in the body) risk falling flat if they don’t consider human experience. Poor uptake, rapid discontinuation, and missed opportunities for impact often follow.
But this isn’t inevitable. By engaging communities early, asking meaningful questions, and listening carefully, we can design interventions that people want to use, not just ones that work on paper.
Designing for Effective HIV Prevention
This lesson has become especially clear in our work across multiple HIV prevention trials with sexual and gender minority communities.
MTN-035, for example, was a multinational study designed to understand whether rectal microbicides (i.e., products applied inside the rectum before sex) could be a viable HIV prevention strategy. These products were needed because while oral PrEP and condoms are effective, they don’t meet the needs of everyone at risk for HIV.
Participants in Thailand, South Africa, Malawi, Peru, and the United States tested three rectal placebo microbicides: a suppository, an insert, and an enema. All three were safe and generally well-received, but what stood out was how differently they were experienced across contexts.
In places where rectal douching was already a common sexual health practice, enemas felt intuitive and easy to adopt. In contrast, in settings where douching was less common, participants gravitated toward simpler or more discreet options, like inserts or suppositories. These differences underscored a central lesson: there is no single “best” product. What feels natural in one country or culture may not resonate in another, and successful HIV prevention depends on designing tools that reflect the realities of people’s daily lives.
Building on these insights, the ATN DREAM study – a Phase 1 clinical trial evaluating the safety and acceptability of a tenofovir-based douche for HIV prevention among young adults- tested whether a biomedical product could be delivered in a form that mirrored practices already common among many participants, such as rectal douching before sex.
The findings extended the lessons of MTN-035 by showing how prevention can be most effective when it integrates seamlessly into existing practices. Together, these studies demonstrated that biomedical effectiveness is necessary but not sufficient; prevention tools also need to fit comfortably within the daily lives of the people who might use them.
Our current work with Dr. Steven Meanley’s PURPOSE-2 qualitative ancillary study takes this idea a step further. At its core, the study is about listening closely to participants to understand what shapes their willingness to start and stay on long-acting PrEP. Only after centering those voices, can we situate the research within the larger PURPOSE-2 trial, a Gilead-sponsored study testing a long-acting injectable medication (cabotegravir) for HIV prevention.
By focusing first on people’s stories about how injections might fit (or not fit) into their routines, we can anticipate real-world barriers before scale-up. In doing so, the study highlights why acceptability research is not just about gauging preference: it’s about ensuring that promising biomedical tools have the conditions they need to achieve population-level impact.
Taken together, these examples show that product delivery matters. Sensory experience matters. Social context matters. Patient voice is not just a “nice to have;” it’s a cornerstone of effective design.
From Development to Scale: Why Acceptability Matters
Thinking about acceptability only at the end of the pipeline is too late. When a product is already developed, redesigning for usability can be costly and delay access. But if we integrate acceptability research early from the first formulation studies through late-stage trials we can ensure that the products most likely to succeed in the lab are also the ones most likely to succeed in people’s lives.
We’ve already seen this lesson play out with oral PrEP. When it was first introduced, PrEP represented a groundbreaking biomedical tool with the potential to transform HIV prevention. Yet early adoption lagged in many communities, not because of doubts about its effectiveness, but because of the contexts in which people lived. Stigma, pill fatigue, mistrust of the healthcare system, and the burden of daily medication all made consistent use difficult.
Over time, uptake grew as messaging improved, access expanded, and communities were engaged in reshaping how PrEP was offered and talked about. The science never changed but its success depended on whether the product fit into people’s lives.
At scale, the stakes are even higher. Public health programs depend on widespread uptake and sustained use to reduce HIV and STI rates across entire populations. The conclusion is clear: products that people want to use are the ones most likely to deliver real-world impact.
Eidos as a Partner in Human-Centered Innovation
At Eidos, we’ve made it our mission to bridge this gap. Our team translates end-user insights into actionable guidance for product developers, regulators, and public health programs. Our role is to help ensure that health technologies don’t just make it to market, but also make it into people’s lives in ways that are sustainable, empowering, and equitable.
The future of LGBTQ+ health equity won’t be driven by science alone. It will be shaped by our willingness to put people first and to build innovation around their needs. Otherwise, we risk creating the Google Glass of HIV prevention: technically brilliant, but left unused.