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are able to promote products because of their perceived the population identifying as vegetarian has increased,
authenticity) could raise awareness of health interventions the fast-food outlets have adapted to offer vegetarian
and normalise their use. 10 meals. Responsiveness to customer feedback and popular
4. Life Tastes Good: This was originally a 2001 campaign trends is prioritised, with a focus on user-driven product
slogan for Coca Cola. This phrase captures the fast-food development. Conversely, within healthcare a pathogenic
industry’s main message: this tastes good and by eating it focus can overshadow user-demand considerations.
your life will be good too. The message is gain framed, Although biomedical and behavioural interventions take
with an emphasis on the reward. Biomedical products for years to move from concept to market, reducing their
HIV such as antiretroviral therapy, oral pre-exposure ability to be responsive, healthcare promotion and
prophylaxis (PrEP), voluntary male medical circumcision delivery can adapt to meet users’ needs and preferences.
(MMC) and condoms have many positive benefits, yet
are often offered within a negative framework that
focuses on risk aversion and the negative consequences Among adolescents, healthcare is one of many competing
of not using the product. HIV, STI and pregnancy priorities. This makes it easy to put off clinic visits and
prevention might benefit from gain-frame messages such regular health checks. As sub-Saharan Africa continues to
as the ‘Do what you want. Do it with love, respect, and develop and secure access to low-cost, fast services, the
condoms’ slogan employed by youth-led Youth Against modern African adolescent may not only demand but start to
AIDS organisation. 11,12 expect healthcare delivery systems that fit their faster
5. Fast food is cheap, as are public healthcare services in SA. environment.
However, indirect costs such as transport to the facility
and opportunity costs for missing work or school References
constitute real barriers to access. These costs could be
circumvented through decentralised healthcare services 1. Patton GC, Sawyer SM, Santelli JS, et al. Our future: A Lancet commission on
adolescent health and wellbeing. Lancet (London, England). 2016;387(10036):
that operate at flexible hours. 2423–2478.
6. Fast-food outlets are places to socialise. Outlets benefit when 2. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS update.
Seizing the moment: Tackling entrenched inequalities to end epidemics. 2020.
customers are happy to be seen there. Building positive Geneva; UNAIDS.
social associations with attendance is a way in which 3. Smith P, Marcus R, Bennie T, et al. What do South African adolescents want in a
sexual health service? Evidence from the South African studies on HIV in
clinics could attract healthy individuals and patients into adolescents (SASHA) project. S Afr Med J. 2018 Jul 25;108(8):677–681. https://
the space. This can be achieved by making the healthcare doi.org/10.7196/SAMJ.2018.v108i8.13013
spaces attractive and adolescent friendly, normalising 4. Egbujie BA, Grimwood A, Mothibi-Wabafor EC, et al. Impact of ‘Ideal Clinic’
implementation on patient waiting time in primary healthcare clinics in Kwa-Zulu
visits and offering linkage to in-person or virtual peer Natal Province, South Africa: A before and after evaluation. SAMJ.
2018;108(4):311–318. https://doi.org/10.7196/SAMJ.2018.v108i4.12583
support linkages. Health promotion is supported by 5. QSR Magazines. The 2019 QSR drive-thru study: Speed of service [homepage on
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quick, delivered by friendly, non-judgemental staff, and 6. Girometti N, McCormack S, Devitt E, et al. Evolution of a pre-exposure prophylaxis
provided an overall positive experience. 3 (PrEP) service in a community-located sexual health clinic: Concise report of the
PrEPxpress. Sex Health. 2018 Nov;15(6):598–600. https://doi.org/10.1071/SH18055
7. Providing choice: Fast-food outlets offer menus that can be 7. Whitlock GG, Gibbons DC, Longford N, Harvey MJ, McOwan A, Adams EJ. Rapid
tailored to preferences and specific dietary requirements. testing and treatment for sexually transmitted infections improve patient care and
The HIV response is well-positioned to offer choice, yield public health benefits. Int J STD AIDS. 2018 Apr;29(5):474–482. https://doi.
org/10.1177/0956462417736431
particularly around prevention options. Choices can be 8. Athens JK, Duncan DT, Elbel B. Proximity to fast-food outlets and supermarkets as
tailored to provide an ‘adolescent menu’ of oral PrEP, predictors of fast-food dining frequency. J Acad Nutr Diet. 2016;116(8)1266–1275.
https://doi.org/10.1016/j.jand.2015.12.022
condoms and MMC or a menu for sexually and 9. Ahmed N, Pike C, Bekker LG. Scaling up pre-exposure prophylaxis in sub-Saharan
gender diverse persons, including condoms, lubricant Africa. Curr Opin Infect Dis. 2019; 32(1):24–30. https://doi.org/10.1097/
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oral PrEP, MMC and, when they become available, 10. PIXLESS. Instagram influencer: Definition [homepage on the Internet]. [cited 2020
effective rectal microbicides. Choices can change as your Jul 20] Available from: https://www.pixlee.com/definitions/definition-instagram-
influencer
risk or preference changes. Promoting choice supports 11. Youth against AIDS [homepage on the Internet]. [cited 2020 Jul 20]. Available
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8. Keep up. The fast-food industry is constantly evolving to 12. Morton JF, Myers L, Gill K, et al. Evaluation of a behavior-centered design strategy
for creating demand for oral PrEP among young women in Cape Town, South Africa.
meet customers’ dynamic demands. As the proportion of Gates Open Res. 2020 Jul 3;4:29. https://doi.org/10.12688/gatesopenres.13103.2

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