HIV Preexposure Prophylaxis in Women

Human immunodeficiency virus (HIV) infection is an ongoing problem worldwide, despite highly effective treatment and prevention. 

While most new diagnoses of HIV infection are among men who have sex with men, women made up 19% of new infections (7402 cases) in 2015. A particularly high proportion of women living with HIV are black (in 2014, 60%, compared with 17% each for white and Hispanic or Latina women in the U.S.A.).

PrEP is a single pill containing two anti-HIV drugs, emtricitabine and tenofovir (abbreviated FTC/TDF), sold in the U.S. under the brand name Truvada and has been recommended by the CDC since 2011 for individuals at risk for acquiring HIV. Taken every single day (don't forget), this regimen greatly lessens your likelihood of getting HIV. FTC and TDF are not new drugs. They have been used for many years (along with additional drugs) to treat HIV, and their safety and effectiveness are well known.

Who Should Consider PrEP

Women with the highest possibility of getting infected with HIV are those who:

• Do not regularly use condoms and have sexual contact with one or more partners who are “at risk” for HIV (for instance, men who have sex with men or inject drugs).
• Are in an ongoing sexual relationship with an HIV-positive partner.
• Trade sex for drugs or money.
• Inject drugs.
• Live in an area of the country where HIV is more common (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) or have sex with people within a group or social network where HIV is common.

If You're Considering PrEP

Your first step is to find a clinician (doctor, nurse practitioner, nurse midwife, physician assistant) with whom you can talk openly. Ideally, he or she will ask you directly about your risk factors and about specific things you do during sex (for instance, having anal sex without a condom). If your clinician does not ask, you might need to start the conversation by asking about PrEP. If your clinician is unfamiliar with PrEP or unwilling to prescribe it, you may be able to find a PrEP provider at the PrEP Locator website (see Resources below) or at a local public health clinic for sexually transmitted infections (STIs) or HIV.

PrEP should only be used by people who do not already have HIV, since those who are HIV-positive may need different or additional medications — so to find out if PrEP is appropriate for you, the first step is an HIV test. You will also be tested for hepatitis B virus (HBV). PrEP medication is effective for HBV, too; you can take it for both purposes, but you'll need regular HBV blood tests (if you start FTC/TDF and then stop, the HBV may become active again, damaging your liver). If you do not have HBV and have never been vaccinated for it, you should get the vaccination series. You will also need tests for pregnancy and STIs, as well as a blood test to check that your kidneys are healthy. After you start PrEP, you will need to return at regular intervals to discuss any problems and to get pregnancy, STI, and kidney function blood tests.

When starting FTC/TDF, you may experience mild stomach discomfort, rash, or headache; these side effects usually go away after a few days or weeks. In some cases, long-time use of TDF can cause kidney damage.

Even if you use PrEP you also need to use condoms, because they protect you against more than just HIV. PrEP does not prevent other STIs — you can still get chlamydia, gonorrhea, syphilis, and other STIs that can cause serious health problems. Another reason to continue using condoms for at least 3 weeks after you start PrEP is that it takes this long for the medication to get into the tissues of your vagina and cervix to start protecting you. Even if your partners refuse to use condoms, an advantage of PrEP is that you can use it without partners knowing.