Health workers typically approach gay and bisexual men for counseling about drugs to prevent HIV. But that leaves women who may be at risk out of the conversation.
Written by David Heitz
Written by David Heitz
In the two years since the U.S. Food and Drug Administration (FDA) approved the use of Truvada for HIV prevention, almost all outreach efforts have targeted men.
“PrEP legitimately has been framed as an intervention for high-risk men, particularly gay men, and that’s all good,” Kimberleigh J. Smith of Harlem United Community AIDS Center in New York City told Healthline. “But the fact remains, PrEP is an option for women.”
Smith is one of a half dozen women who will appear on a panel at 6 p.m. Tuesday at Mount Sinai Roosevelt Hospital in New York City for a “PrEP Rally,” as the event is being called. Other panelists will include a doctor, a social worker, and three women who either have taken or are taking PrEP.
“PrEP is not an intervention useful for everybody, but it needs to be accessible for everybody, particularly for specific individuals for whom condoms won’t work or can’t work, or for whom traditional HIV prevention is not sustainable,” Smith said.
That includes women in heterosexual relationships with HIV-positive men, including those who are trying to conceive. It also includes female sex workers.
In a study of almost 5,000 heterosexual couples of mixed HIV status in Kenya and Uganda, Truvada as PrEP reduced the chances of the noninfected partner contracting HIV by 75 percent. Among people with detectable levels of the drug in their blood, infection risk was slashed by 90 percent.
Truvada must be taken every day as directed in order to be effective. Participants in the trial were also counseled about safe sex and given condoms.
Using a New Pill to Have a Baby the Old-Fashioned Way
Poppy Morgan of San Francisco, California, will appear on the panel via webcam. In 2012, Poppy conceived in the traditional way with her husband, who is HIV positive. He had (and still has) an undetectable viral load; she took PrEP. She gave birth to a healthy baby in 2013 and is considering using PrEP again to have a second child, she said.
She told Healthline she had initially planned on using a sperm donor for the first baby but changed her mind.
“I was with some friends, and my husband and a friend were walking in front of me talking,” she said. “I was looking at my husband, how he was walking, how his hair looked. I was like, you know, I married him because I love him. I don’t want to look down at my child and say, 'Whose mannerism is that?'”
Couples of mixed HIV status can conceive biologically by first having the male partner’s sperm certifiably stripped of the virus. The process is called sperm washing and can cost as much as $10,000.
Doctors Hesitate to Prescribe PReP for Women
Morgan said she used PrEP for 17 months, taking the pill every single day. Even though she gave birth to a healthy baby and did not contract HIV herself, she said finding a doctor to prescribe Truvada for her was difficult, even in an HIV-conscious city like San Francisco.
“I ended up having to go to my husband’s doctor at an HIV clinic,” she said. “I talked to my primary doctor about prescribing it, but she said absolutely not, it would be unethical for her to do that, that it would be condoning risky behavior.”
Her husband had an undetectable viral load during his most recent HIV test prior to conception. Viral loads can ebb and flow during so-called “blips.” Morgan said her husband had his viral load monitored regularly, and they postponed trying to conceive during such spikes.
She said that once she became pregnant, she took PrEP for an additional 28 days.
Smith said public health officials in New York City are working hard to overcome issues that keep women from accessing PrEP, financial or otherwise. “For women we need to find the right providers and right clinics, and those may not be the same places as those for men," Smith said.
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