U.S. Women and PrEP

Pre-exposure Prophylaxis (PrEP) is gaining traction as an effective HIV prevention option for many people. Most of the public health and advocacy discussion of PrEP in the U.S. has focused on gay men, which makes sense, given that this population still has the highest HIV infection rates in the country. The FDA approved oral Truvada® for PrEP for both men and women in 2012, and CDC issued guidance for clinicians providing PrEP to women in May of 2014. However, there were no clinical trial data on the efficacy of PrEP for women in the U.S. (although there were from others), and almost nothing was known about whether U.S. women even knew about PrEP, much less would be willing to use it.

My colleagues at AIDS United and I undertook a focus group study with 144 women in six U.S. cities in 2013 to examine their knowledge, attitudes, and likelihood of using PrEP, which was just published in AIDS Patient Care and STDs. We found that most women had never heard about PrEP (and were angry that they hadn’t heard about it, given its efficacy), but once they were informed, saw it as an attractive option for HIV prevention for women, assuming its side effects were minimal, its costs were covered by insurance, and it was made available by trusted providers.

Here’s what some of the participants told us:

• “It may just completely slip his mind. It may be something they heard of, but they’re not fluent and know everything about it.” Participant from Newark, referring to her doctor’s knowledge of PrEP.
• ‘‘So if you’re around a community of people who don’t understand or they don’t get it, then you may get the negative look or shunned. So that would kind of stop people from doing it or that would stop people from being open to doing it. But I think if people are widely educated and they understand the complications or the scenarios of what could possibly happen if not, then more people would be open to do it.’’ Participant from Atlanta.
• “I would have to say not right now at this early stage. I would like to see a little more testing done and we could see a little more results done before I take the medication…I don’t want to be a guinea pig. That’s what I’m saying. I don’t want to be a guinea pig.’’ Participant from Chicago.

Given their experiences with contraception, women expressed a preference for different kinds of PrEP formulations and modes of delivery (e.g., pills, vaginal rings, injectables), recognizing that different women like different methods of prevention.

This study is important because, although the number of new HIV infections among U.S. women has been declining, women are still getting infected and need modes of prevention that they can control or initiate themselves more than they can male condoms. As the study shows, PrEP may be one such method of great interest to women, and it’s crucial that health care providers are aware of this.

Take a look at the article here!