Women want Pre-Exposure Prophylaxis but are Advised Against it by Their HIV-positive Counterparts

Introduction:

In 2013, nearly 20% of new HIV infections in the United States (US) occurred among women. Of these new infections, 86% resulted from heterosexual contact with a high-risk mal. Black and Latina women are at increased risk of acquiring HIV compared to all other racial/ethnic groups of women. In 2013, black and Latina women accounted for 63% and 15% of all new HIV infections among women in the US, respectively. 

The latest advancement in HIV prevention, Pre-Exposure Prophylaxis (PrEP), could potentially contribute to reducing HIV infection rates among women. PrEP is a biomedical method that uses antitretroviral medications (ARVs) to prevent HIV in uninfected individuals who are at high risk of becoming infected. In 2012, the US Food and Drug Administration (FDA) approved oral Truvada (tenofovir disoproxil fumarate and emtricitabine) for PrEP among sexually active adults at risk for HIV infection based on two clinical trial. The CDC developed interim guidance for PREP use between 2011 and 2013 for men who have sex with men (MSM), heterosexually active adults, and injection drug users (IDU), followed by comprehensive clinical practice guidelines in May 2014.

Since the approval of Truvada for PrEP in the US, its use has increased considerably among men but remained static for women; a nationwide analysis of PrEP uptake using pharmacy databases showed that the absolute number of females who started PrEP in Quarter 1 of 2012 was 159, and remained flat for 11 quarters (over 3 years) until quarter 3 of 2014; for the same time period, the number of male PrEP users rose from 153 to 1064. The investigators suggest that the increase in PrEP prescriptions in men relative to women is related to growing awareness of PrEP among the MSM population; however, it is not clear why awareness and use among women have not similarly increased.