PrEP (pre-exposure prophylaxis), a drug that prevents HIV transmission upon exposure, is a crucial aspect of HIV prevention. However, not everyone who may benefit from PrEP can access it—some may not even know what PrEP is. Women remain a group that is significantly underrepresented among PrEP users. Although women account for 20% of new HIV diagnoses, less than 10% of women in the US who could benefit from PrEP end up getting a prescription for PrEP.
What stands in the way between women and PrEP?
Studies have demonstrated that stigma, bias, and cultural narratives surrounding PrEP and HIV are key factors that impact PrEP access and PrEP uptake among women. “PrEP campaigns have really focused on the LGBTQ community—and on gay men, in particular,” GMHC Senior Director of Testing and Prevention Services Omi Singh explains, “women do not see themselves in PrEP commercials, or public awareness campaigns. Their doctors aren’t talking to them about it, their friends aren’t discussing it among themselves—PrEP is just not on many women’s radars. And it should be!” Intentionally including women in campaigns and conversations regarding HIV prevention, is an important step in shifting the cultural narrative about PrEP, and ensuring that women can confidently access the resources they need to get PrEP.
Stigma and lack of knowledge regarding HIV can prevent individuals from seeking out HIV prevention resources, like PrEP. For example, a 2016 study showed that many women weren’t seeking out HIV prevention resources because they did not know they could benefit from them. Stigma surrounding HIV also discourages women from disclosing their potential HIV risks to healthcare providers.
Healthcare providers are not wholly immune to stigma and bias. They must take an active role in countering HIV stigma by ensuring that their clients are properly informed about HIV prevention options regardless of their gender identity, sexuality, marital status, race, or socioeconomic status. Singh points out, “talking about and prescribing PrEP needs to be normalized at the primary care and gynecological care levels. PrEP needs to be in the same conversations as STI testing, birth control/pregnancy planning, and cancer screenings.”
Although women do not make up the majority of HIV diagnoses, it is still imperative that we empower women to access and utilize PrEP. By using PrEP, women can discreetly control their sexual health—without having to rely on their sexual partner(s) to remain monogamous, get tested, or use a condom.
What can we do we shift the narrative about PrEP to ensure that women have equitable access to the medication?
Education and inclusion are two crucial methods. When women are directly included in HIV prevention campaign materials, as well as HIV service spaces, they can get information and support to take control of their sexual health—including seeking out options such as PrEP. “At the GMHC Testing Center, we see people of all gender identities and sexualities,” Singh says. “Our sessions are individualized to each client. Our goal is to treat them with care and respect and ensure they have the information and tools to use to take care of themselves in the future.” GMHC hosts a variety of workshops and support groups specifically targeted towards women that aim to increase knowledge of HIV transmission and prevention. In addition to social factors, many women who belong to socioeconomically marginalized groups cannot afford PrEP. Luckily, at GMHC, clients who face financial barriers can get connected to programs that help mitigate the cost of PrEP.
“It needs to be emphasized that PrEP works for women,” Singh concludes. “It’s empowering—revolutionary even—for women to prioritize their sexual wellbeing in a society that is still so often suppressive and shaming of women’s sexuality.”
