Prevention for Women

Welcome! This page contains resources relevant to HIV prevention for U.S. women – inclusive of trans and cis women. The resources have been selected by HIVE in collaboration with many HIV prevention advocates nationwide.

To view more resources specifically geared towards trans women, please visit hiveonline.org/prep4transwomen.

New resources will be added as they become available. Have suggestions for resources? Let us know! Email Yamini: yamini@hiveonline.org.

Resources for You

HIV is more preventable than ever. You may already know about HIV prevention options such as male and female condoms, screening and treating sexually transmitted infections, and regular HIV testing—but let’s talk about a few more: PrEP, PEP, and TasP/U=U

➔ PrEP, or pre-exposure prophylaxis, is a daily pill to help keep you HIV-negative. When taken as prescribed, PrEP is highly effective. PrEP is safe and generally well tolerated. Most insurance plans (public and private) cover PrEP.

PrEP works for women, men, people of transgender experience, people of all sexual orientations and gender identities, youth, and people who inject drugs.

➔ PEP, or post-exposure prophylaxis, is a combination of medications you can take AFTER a possible exposure to HIV. PEP is most effective the sooner it’s started, and must be started within 72 hours of the exposure. PEP is taken daily for 28–30 days

➔ Undetectable, TasP, or treatment as prevention, is when a person living with HIV takes medications to keep the virus at very low levels (called undetectable). Many large studies show that people who take their HIV medicines daily as prescribed and maintain an undetectable viral load have effectively no risk of passing HIV through sex. This concept is also known as U=U, short for “undetectable = untransmittable.”

You can support your partner in staying undetectable by helping them take their HIV medications and access medical care.

You can use these HIV-prevention strategies alone or in combination to reduce your risk of getting HIV and take charge of your sexual health!

 

  • PrEP for Sex (webpage) by New York State Department of Public Health

 

For Transwomen

1. PrEP for Transwomen: A collection of resources (webpage)

Social Media/Community Building

Training Resources

  1. National CBA Provider Network (free technical assistance)

Advocacy Resources

  1. Facebook Group: PrEP Facts: Women’s Sexuality & HIV Prevention
  2. HIVE’s Resources for PrEP Implementation
  3. HIVE ::Hangouts with HIVE::
  4. National Female Condom Coalition
  5. PrEP Watch: A Clearinghouse for PrEP Information
  6. PrEP Access Advocates: Listserv of PrEP Advocates from around the U.S. To join, email avac@avac.org

 

 

In the Media

  1. The Body: Celebrating HIV Prevention Choices for Women and Receptive Sex Partners of All Genders by Anna Forbes
  2. Poz: There’s Never Been a Better Time to Get Pregnant If One of You Has HIV by Ben Ryan
  3. Huffington Post: Trusting Women, Shared Decision-Making & The Possibility Of PrEP by Shannon Weber & Dr. Dominika Seidman
  4. Huffington Post: PrEP For Her: Bringing Women Into The HIV Prevention Conversation by Mehroz Baig
  5. Huffington Post: Uptake of PrEP Among U.S. Women: Knowledge Is Power by Shannon Weber, Anna Forbes & the U.S. Women & PrEP Working group
  6. Women’s Health Mag: There’s a Drug That Prevents HIV—So Why Don’t More Women Know About It? By Kristina Marusic
  7. Huffington Post: Making PrEP Possible for Women by Shannon Weber, Jessica Terlikowski & Dr. Dominika Seidman
  8. Black Lives Matter: What’s PrEP Got to Do with It?  by the Black AIDS Institute

Bibliography

This is a selected bibliography of research relevant to HIV prevention for U.S. women. It includes citations on condoms, pre-exposure prophylaxis, post-exposure prophylaxis, and treatment as prevention.

The following questions helped narrow the parameters:
– Does this reference move forward HIV prevention implementation?
– Are the findings new or novel?
– Are the conclusions relevant to HIV-negative U.S. women?
– Will the findings be relevant a year from now?
– Is the publication well written and easy to understand?
– Is the data helpful for HIV prevention implementers?

Included are papers published since 2014 and conference abstracts from HIV & Women Conference, Conference on Retroviruses and Opportunistic Infections (CROI), and the IAPAC Adherence Conference in 2017 and 2018.

Treatment as Prevention, Viral Supression, ART/ARV

Conception, Pregnancy & Breastfeeding

Effects of Antiretroviral Therapy to Prevent HIV Transmission to Women in Couples Attempting Conception When the Man Has HIV Infection – United States, 2017. Brooks JT, Kawwass JF, Smith DK, Kissin DM, Lampe M, Haddad LB, Boulet SL, Jamieson DJ.

It is recommended that men who are HIV-positive are virally suppressed before attempting to conceive. Research supports that ART is highly effective in reducing the risk of HIV transmission.

Missed Opportunities for Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus. Scott GB, Brogly SB, Muenz D, Stek AM, Read JS; International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT) P1025 Study Team.

Among a national sample of HIV-infected women, 12 infants were infected with HIV: “four transmissions occurred in utero, three were peripartum transmissions, and the timing of transmission for five neonates was unable to be determined.

Perinatal Antiretroviral Exposure and Prevented Mother-to-child HIV Infections in the Era of Antiretroviral Prophylaxis in the United States, 1994-2010. Little KM, Taylor AW, Borkowf CB, Mendoza MC, Lampe MA, Weidle PJ, Nesheim SR.

As a direct result of interventions designed for the prevention of mother-to-child transmission, particularly ARV drugs during the perinatal and postpartum periods 21,956 mother-to-child transmissions have been prevented since 1994.

Pregnant and breastfeeding women: A priority population for HIV viral load monitoring. Myer L, Essajee S, Broyles LN, Watts DH, Lesosky M, El-Sadr WM, Abrams EJ.

Authors propose key clinical (e.g. When and how frequently should VL monitoring be conducted during pregnancy and breastfeeding to maximise the detection of elevated VL, balancing clinical benefits with costs and operational complexity?), behavioral (e.g, What are the drivers of ART non adherence during pregnancy and breastfeeding?), and health systems (e.g., How can steps in the VL cascade be expedited to minimize delays from specimen collection to clinical action?) questions to be addressed around viral load monitoring among pregnant and breastfeeding HIV-positive women.

Reproductive health counseling delivered to women living with HIV in the United States. Gokhale RH, Bradley H, Weiser J.

Due to advances in ART maternal-to-child transmission has been reduced to < 1%. However, HIV care providers are not adequately trained to provide comprehensive reproductive health counseling: “49% reported delivering all components of comprehensive reproductive health counseling; 71% assessed reproductive intentions of reproductive-aged women, 78% explained perinatal transmission risk; 87% discussed ART for preventing perinatal transmission; 76% provided contraception as appropriate, and 64% provided referrals for preconception care.” Being a primary care provider was the only factor associated with providing comprehensive reproductive care after adjusting for control variables.

Trends in antiretroviral drug use during pregnancy among HIV-infected women on medicaid: 2000-2007. Phiri K, Fischer MA, Mogun H, Williams PL, Palmsten K, Seage GR 3rd, Hernandez-Diaz S.

From 2000-2007, <1% (n=2856) of women were diagnosed with HIV. Higher incidences of HIV among pregnant women were present in DC, Maryland, and New York. About one-quarter of women did not have an ARV dispensed during pregnancy. Women with limited health care utilization were less likely to have ARV dispensed during pregnancy.

Management of HIV Infection during Pregnancy in the United States: Updated Evidence-Based Recommendations and Future Potential Practices. Rimawi BH, Haddad L, Badell ML, Chakraborty R.

This article summarizes the current recommendations for combination antiretroviral therapy to prevent mother-to-child transmission in the United States.

Differentiated Approaches (Transgender)

Acceptability and Feasibility of HIV Self-Testing Among Transgender Women in San Francisco: A Mixed Methods Pilot Study. Lippman SA, Moran L, Sevelius J, Castillo LS, Ventura A, Treves-Kagan S, Buchbinder S.

Transgender women were highly favorable of home HIV testing and preferred this approach over testing in a clinic setting. Key barriers to home tests included cost and the lack of support to process positive test results.

Differentiated Approaches

ARV-based HIV prevention for women – where we are in 2014. Mastro TD, Sista N, Abdool-Karim Q.

This article highlights the need for providing women a variety of methods to prevent HIV, particularly more women-controlled options such as PrEP.

Biomedical Approaches to HIV Prevention in Women. Heumann CL.

Research supports that oral PrEP adherence is extremely low among exclusively women samples. Findings from this review support the need for continued research “to identify the most efficacious and acceptable agents for women.”

Comprehensive Sexual Health

Biomedical technologies for the prevention of sexually transmitted infections and HIV for adolescent girls and young women. Narasimhan M, Vermund SH, Ogilvie G.

Approximately, 65% of HIV incidences internationally are among adolescent girls and young women aged 10-24. Despite the high incidences of HIV among this population, the international public health agenda has not focused on reducing HIV/STIs among this population. Narasimhan et al. recommends that public health take a multi-sectoral and rights-based approach to increase and improve the accessibility to sexual and reproductive health services including HIV/STI prevention methods as a mode to empower adolescent girls and young women.

Beyond the Pap Smear: Gender-responsive HIV Care for Women. Meyer JP, Womack JA, Gibson B.

This article provides clinical (e.g., considering women’s other medications such as contraception when distributing ART), community (e.g., include women in the conversation about reproductive rights), and integrated (e.g., address structural barriers related to HIV testing and care) recommendations to provide HIV-positive women holistic care.

Condom Use

Condomless Sex Among Virally Suppressed Women With HIV With Regular HIV-Serodiscordant Sexual Partners in the Era of Treatment as Prevention. Patterson S, Carter A, Nicholson V, Webster K, Ding E, Kestler M, Ogilvie G, de Pokomandy A, Loutfy M, Kaida A.

About half (55%) of virally suppressed HIV-positive women reported having condomless sex in the past 6 months. Factors associated with condomless sex included knowing the benefits of ART, being in a relationship, being White, and living in British Columbia.

Condomless sex and HIV transmission among serodifferent couples: current evidence and recommendations. Koff A, Goldberg C, Ogbuagu O.

There are many benefits of condomless sex for serodifferent couples. Medical providers should be equipped to fully explore serodifferent couples sexual risk and recommend HIV prevention methods accordingly. Recommended issues providers should consider are the following: “the type and frequency of sexual intercourse, the presence of sexually transmitted infections including genital HSV, circumcision status, frequency of condom use, the presence of partners outside of the primary relationship, duration of treatment and adherence of the seropositive patient to ART, interest of the seronegative patient in PrEP, and a general assessment of risk-taking behaviour which includes sexual impulsivity or unplanned sexual encounters and drug or alcohol use.”

Care Cascade/Continuum

Factors associated with lack of viral suppression at delivery among highly active antiretroviral therapy-naive women with HIV: a cohort study. Katz IT, Leister E, Kacanek D, Hughes MD, Bardeguez A, Livingston E, Stek A, Shapiro DE, Tuomala R.

Factors associated with lack of viral suppression at delivery among women taking highly active ART included identifying as Black, multiparity, having less than a high school education, being diagnosed with HIV before the current pregnancy, late initiation of prenatal care, and initiation of HAART in the third trimester.

HIV RNA Suppression during and after Pregnancy among Women in the HIV Outpatient Study, 1996 to 2015. Patel M, Tedaldi E, Armon C, Nesheim S, Lampe M, Palella F Jr, Novak R, Sutton M, Buchacz K; HOPS Investigators

Findings from this study support that it is challenging for women to maintain viral suppression before, during, and after pregnancy, with peak in nonsuppression during the postpartum period.

HIV Testing, Linkage to HIV Medical Care, and Interviews for Partner Services Among Women – 61 Health Department Jurisdictions, United States, Puerto Rico, and the U.S. Virgin Islands, 2015. Stein R, Xu S, Marano M, Williams W, Cheng Q, Eke A, Moore A, Wang G.

“Among 4,749 women tested who received a diagnosis of HIV infection, 2,951 (62%) had received a diagnosis in the past (previous diagnosis), and 1,798 (38%) were receiving a diagnosis for the first time (new diagnosis). Of those who had received a previous diagnosis, 87% were not in HIV medical care at the time of the current test.”

Condoms

Male/Female Condom Use

Alcohol, Intercourse, and Condom Use Among Women Recently Involved in the Criminal Justice System: Findings from Integrated Global-Frequency and Event-Level Methods. Weir BW, Latkin CA.

Among women involved in the judicial system, there was not an association between alcohol and condom use.

Assessing and Mapping the Availability of the Female Condom in the Philadelphia Metropolitan Area. Cavanaugh C, Mial K, Tulloch D.

In Philadelphia  only 1% of service providers sold the female condom compared to 77% that sold the male condom. Findings support the need to increase female condom availability.

Consistency of Condom Use During Receptive Anal Intercourse Among Women and Men Who Have Sex With Men: Findings From the Safe in the City Behavioral Study. D’Anna LH, Warner L, Margolis AD, Korosteleva OA, O’Donnell L, Rietmeijer CA, Klausner JD, Malotte CK; Safe in the City Study Group.

About 31% of women reported using condoms during anal sex. Factors associated with condom use during anal sex were “intention to use condoms, partner support for condom use, the belief they could stop having sex when condoms were unavailable, and believing their partner had not given them a sexually transmitted infection (STI) were associated with using condoms consistently.”

Female Condom Use and Adoption Among Men and Women in a General Low-Income Urban U.S. Population. Weeks MR, Zhan W, Li J, Hilario H, Abbott M, Medina Z.

Factors associated with women’s female condom use included having positive attitudes about the female condom, network exposure, and peer influences and norms.

Predictors of condom use in women receiving court-mandated drug and alcohol treatment: implications for intervention. DePesa NS, Eldridge GD, Deavers F, Cassisi JE.

Women in court-mandated drug abuse treatment were less likely to use condoms if they were in a committed relationship and had an older partner. Higher percentages of women who reported positive condom outcomes were more likely to report condom use.

Women at risk of HIV can continue to use hormonal contraception but with condoms. Gulland A.

Women who use hormonal contraception, particularly the depo shot, are double time as likely to acquire HIV. WHO and UNAIDS called for a need to develop and prevent safe contraception and HIV prevention methods that women can own and manage.

Women’s willingness to experiment with condoms and lubricants: A study of women residing in a high HIV seroprevalence area. Sanders SA, Crosby RA, Milhausen RR, Graham CA, Tirmizi A, Yarber WL, Beauchamps L, Mena L.

Among a predominately Black sample of women from an STI clinic, the majority was ” willing to: (1) experiment with new types of condoms and lubricants to increase their sexual pleasure, (2) touch/handle these products in the absence of a partner, and (3) suggest experimenting with new condoms and lubricants to a sex partner.”

Post-Exposure Prophylaxis

PEP Provision

A Qualitative Exploration of Sexual Assault Patients’ Barriers to Accessing and Completing HIV Prophylaxis. Djelaj V, Patterson D, Romero CM.

Emergency department sexual assault forensic examiners identified a series of barriers in providing PEP to patients including: “providers inconsistently offering prescriptions for the correct medication, difficulty locating a local pharmacy stocking nPEP, additional steps uninsured patients may have to complete to access nPEP,  patients’ emotional distress and fear of acquiring HIV impeding their ability to comprehend information and access nPEP, and patient’s expressed that the 28-day nPEP regimen might be a daily reminder for patients of the sexual assault.”

Current practice of HIV postexposure prophylaxis treatment for sexual assault patients in an emergency department. Krause KH, Lewis-O’Connor A, Berger A, Votto T, Yawetz S, Pallin DJ, Baden LR.

Among females who experienced a sexual assault, all women who met criteria were offered PEP. Over 80% of women received PEP; however, only 27.4% completed the 28-day regime.

HIV post-exposure prophylaxis provided at an urban paediatric emergency department to female adolescents after sexual assault. Merchant RC1, Keshavarz R, Low C.

About half of female adolescent assaults who experienced a vaginal sexual assault are provided PEP in emergency departments. The majority of female adolescents knew the person who assaulted them but did not know their HIV status. The majority of female adolescents presented at the emergency room more than 12 hours after the assault and was not provided PEP in the optimum window.

Pre-Exposure Prophylaxis

PrEP Screening, Eligibility & Guidelines

A Missed Opportunity for U.S. Perinatal Human Immunodeficiency Virus Elimination: Pre-exposure Prophylaxis During Pregnancy. Fruhauf T, Coleman JS.

About 10% of pregnant women in the US are eligible for PrEP. Pregnant women who were younger, Black, single, have children, and smoked during pregnancy were more likely to be eligible for PrEP at any time-point during pregnancy.

Offering pre-exposure prophylaxis for HIV prevention to pregnant and postpartum women: a clinical approach. Seidman DL, Weber S, Cohan D.

There are inadequate clinical tools and guidelines to identify women who are vulnerable to HIV and eligible for PrEP. Seidman et al. developed a shared-decision making guide that can be used across the reproductive-life span that assesses women’s vulnerabilities, capabilities, preferences, and opportunities to prevent HIV.

Optimizing Delivery of HIV Pre-Exposure Prophylaxis for Women in the United States. Aaron E, Blum C, Seidman D, Hoyt MJ, Simone J, Sullivan M, Smith DK.

PrEP uptake among women in the US is low. Aaron et al. developed a tool that can identify women who may benefit from PrEP and flowcharts on how to screen for, initiate, and follow-up on PrEP for women.

2018 8th Women and HIV Abstract 55: Implementation strategies to universally screen, educate about, and offer PrEP to pregnant women at two United States medical centers. Seidman D, Weber S, Scott H, Nordell M, Anderman J, Monaghan K, Timoney M

2018 8th Women and HIV Abstract 59: Reaching High Risk Women for PrEP: Learning from ARV-based HIV prevention trials. Hoke T, Stankevitz K, Schwartz K, Li Y, Mahaka I, Mullick S

CROI 2018 Abstract Number 1048: Predictors of PrEP Eligibility Among At-risk Women in the Southern United States. Anar S. Patel, Lakshmi Goparaju, Jessica M. Sales, Cyra Christina Mehta, Oni J. Blackstock, Dominika Seidman, Igho Ofotokun, Mirjam-Colette Kempf, Margaret Fischl, Elizabeth T. Golub, Adaora Adimora, Audrey French, Gina Wingood, Seble Kassaye, Anandi N. Sheth

PrEP Uptake & Adherence

A Review of HIV Pre-Exposure Prophylaxis: The Female Perspective. Bailey JL, Molino ST, Vega AD, Badowski M.

This paper identified several barriers to PrEP uptake among women (e.g., lack of perceived risk,  preference of long-acting forms of PrEP, medical mistrust) and pharmacotherapy considerations for women patients (e.g., pharmacokinetics, PrEP use across the reproductive-span).

Adherence and Acceptability of a Multidrug Vaginal Ring for HIV Prevention in a Phase I Study in the United States. van der Straten A, Panther L, Laborde N, Hoesley CJ, Cheng H, Husnik MJ, Horn S, Nel A, Soto-Torres L, Chen BA.

This study was focused on HIV-negative women who were sexually abstinent to assess the acceptability and adherence of PrEP through a vaginal ring. Approximately, 94% of women reported being adherent throughout the 28-year study period, where two women reported issues with the ring coming out. Preference for continuous (43%), episodic (4%), or no preference (52%) of use varied across women.

Brief Report: Preventing HIV-1 Infection in Women Using Oral Preexposure Prophylaxis: A Meta-analysis of Current Evidence. Hanscom B, Janes HE, Guarino PD, Huang Y, Brown ER, Chen YQ, Hammer SM, Gilbert PB, Donnell DJ. Meta-analysis results supports that high adherence (75%) is associated with PrEP effectiveness among women in Sub-Saharan Africa.

HIV pre-exposure prophylaxis and early antiretroviral treatment among female sex workers in South Africa: Results from a prospective observational demonstration project. Eakle R, Gomez GB, Naicker N, Bothma R, Mbogua J, Cabrera Escobar MA, Saayman E, Moorhouse M, Venter WDF, Rees H; TAPS Demonstration Project Team.

PrEP as an HIV prevention method is acceptable among female sex workers in South Africa. Although retention rates were low, female sex workers were 70-80% adherent to daily PrEP use over a 12-month time-period.

HIV pre-exposure prophylaxis for women. Sheth AN, Rolle CP, Gandhi M.

Although research suggest PrEP when used consistently is effective in HIV prevention among women, it is an underutilized prevention method among this population. To increase PrEP uptake among women, authors recommend “the development of new drugs and delivery systems, and integrating PrEP delivery with reproductive healthcare services.”

When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling. Namey E, Agot K, Ahmed K, Odhiambo J, Skhosana J, Guest G, Corneli A.

This study explored when and if women would start and stop PrEP to prevent HIV over a six-month time-period. Study results indicated that the majority of women would not stop PrEP use, however, among women.

2017 7th Women and HIV Abstract 23: A unique population: adherence to PrEP among HIV negative women attempting conception with HIV positive male partners in the US. Aaron E, Leech A, Nkwihoreze H, Drainoni M, Miller E, Coleman Fennell J, Anderson P, Cabral H, Sullivan M

2018 8th Women and HIV Abstract 51: Dapivirine vaginal ring use: attitudes and experiences across age groups. Malherbe M, Nel A, Smit J, Greener L, Milford C

2018 8th Women and HIV Abstract 53: Vaginal ring acceptability, adherence and social effect: from phase I to phase III. Malherbe M, Martins J, Isaacs M, Nel

CROI 2018 Abstract Number 1049: Risk Behavior, Perception, and Reasons for PrEP Among Young African Women in HPTN 082. Connie L. Celum, Sinead Delany-Moretlwe, Sybil Hosek, Bonnie J. Dye, Linda-Gail Bekker, Nyaradzo Mgodi, Wonderful Mabuza, Goodness Zoh Mvuyane, Shorai Mukaka, Deborah J. Donnell, Subash Pathak, Heather Noble, Denni Lennon, Jessica M. Fogel, Peter L. Anderson

Adherence 2016 Abstract Number OA90: Adherence to PrEP among HIV Negative Women Attempting Conception with HIV-Positive Male Partners in the United States. Emily Stinnett Miller, Margaret Sullivan , Mari-Lynn Drainoni , Jenell Coleman, Helen Koenig, Howard Cabral, Peter Anderson, Ashley Leech, Erika Aaron (presenting).

Adherence 2017 Abstract Number OA104: PrEP Uptake among Cisgender Women at an Urban, Community-Based STI Clinic. Sachin Jain, Cedric Bien, Uri Felsen, Viraj Patel, Oni Blackstock (presenting)

CROI 2018 Abstract ID 1014: Increasing PrEP Uptake, Persistent Disparities, in At-risk Patients in a Boston Community Health Center. Kenneth H Mayer, Chris Grasso, Kenneth Levine, Douglas S Krakower, Victoria Powell, Stephen Boswell, Julie L Marcus

CROI 2018 Abstract ID 1017: Acceptability of Pre-Exposure Prophylaxis (PrEP) Among a Large Cohort of Young Transgender Women in Two U.S. Cities:  Findings from LifeSkills Study. Arjee J Restar, Lisa Kuhns, Sari L Reisner, Robert Garofolo, Matthew J Mimiaga

Adherence 2017 Abstract 181: A Unique Population: Adherence to PrEP among HIV-Negative Women Attempting Conception with HIV-Positive Male Partners in the US. Erika Aaron (presenting), Ashley Ann Leech, Mari-Lynn Drainoni, Emily Stinnett Miller, Jenell Coleman, Peter Anderson, Howard Cabral, Margaret Sullivan

Adherence 2017 Abstract 228: Barriers and Facilitators to Uptake and Adherence to Oral PrEP among Transgender Women in New York City. Christine Rael (presenting), Walter Bockting, Caitlin MacCrate, Michelle Martinez, William Mellman, Rebecca Giguere, Pablo Valente, George Greene, Richard D’Aquila, Susan Sherman, Katherine Footer, Alex Carballo-Diéguez

Adherence 2017 Abstract 384: Health, Intimacy, HIV-Related Anxiety, and Stigma: Perspectives of Women Prescribed HIV Pre-Exposure Prophylaxis at an Urban, Community-Based Sexual Health Clinic. Connie Park, Tonya Taylor, Minia Nataly Rios Gutierrez, Rabea Khedemi, Caryn Weiss, Eileen Dolce, Barry Zingman, Oni Blackstock (presenting)

Potential User Knowledge, Attitudes, Beliefs

Acceptability of Antiretroviral Pre-exposure Prophylaxis from a Cohort of Sexually Experienced Young Transgender Women in Two U.S. Cities. Restar AJ, Kuhns L, Reisner SL, Ogunbajo A, Garofalo R, Mimiaga MJ.

Transgender women who had higher acceptability scores of PrEP use were more likely to be interested in PrEP and have a primary healthcare provider that addressed their needs.

Acceptability of microbicidal vaginal rings and oral pre-exposure prophylaxis for HIV prevention among female sex workers in a high-prevalence US city. Peitzmeier SM, Tomko C, Wingo E, Sawyer A, Sherman SG, Glass N, Beyrer C, Decker MR.

Among female sex workers in Baltimore, high percentages of women were interested in PrEP oral tablets (65%) and vaginal ring (76%). About 12% of women were interested in PrEP and not rings. Women who recently experienced intimate partner violence were more interested in PrEP use. Findings from this study support the need for multiple PrEP options and increased availability to women who may be experiencing violent sexual encounters.

Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City.  Rael CT, Martinez M, Giguere R, Bockting W, MacCrate C, Mellman W, Valente P, Greene GJ, Sherman S, Footer KHA, D’Aquila RT, Carballo-Diéguez A.

Transgender women identified barriers (e.g., uncomfortable side effects, stigma, advertising not including trans women) and facilitators (e.g., reducing pill size, increased studies being conducted among trans women) to PrEP use.

HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood. Calabrese SK, Dovidio JF, Tekeste M, Taggart T, Galvao RW, Safon CB, Willie TC, Caldwell A, Kaplan C, Kershaw TS.

PrEP associated stereotypes and expected PrEP disapproval were associated with discomfort in discussing PrEP use with providers. Women who had low anticipations of PrEP stereotypes and disapproval had greater intentions to use PrEP.

HIV Risk perception and eligibility for pre-exposure prophylaxis in women involved in the criminal justice system. Rutledge R, Madden L, Ogbuagu O, Meyer JP.

Despite women who are involved in the criminal justice system risk for HIV, only 25% of women reported awareness of PrEP with 1/125 who was using PrEP. After receiving information on PrEP 90% of women reported they would try PrEP if recommended by their provider.

‘I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Sevelius JM, Keatley J, Calma N, Arnold E.

PrEP awareness was low, while interest was high among trans women. Barriers to PrEP use among trans women include “ack of trans-inclusive marketing of PrEP, prioritisation of hormone use, and medical mistrust due to transphobia.” Findings from this study support the need for tailored advertising and prescription of PrEP to trans women.

Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. Auerbach JD, Kinsky S, Brown G, Charles V.

Women expressed anger around the lack of PrEP advertisement for women. Women mentioned being interested in using PrEP as an HIV prevention method along with consistent condom use.  Barriers to PrEP uptake identified by women were cost, stigma, and medical distrust.

Perspectives on HIV prevention among urban black women: a potential role for HIV pre-exposure prophylaxis. Flash CA, Stone VE, Mitty JA, Mimiaga MJ, Hall KT, Krakower D, Mayer KH.

Black women are interested in PrEP as a mode to prevent HIV especially as an alternative approach to condom use. Women preferred oral as opposed to gel form of PrEP and daily dosage compared to episodic use.

Predictors of HIV-related risk perception and PrEP acceptability among young adult female family planning patients. Garfinkel DB, Alexander KA, McDonald-Mosley R, Willie TC, Decker MR.

About 60% of young women consider taking a daily pill to prevent HIV. Being  a Black woman or having traded sex was associated with PrEP acceptability. Intimate partner violence was the only factor associated with lower PrEP acceptability among this sample.

Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men. Eaton LA, Kalichman SC, Price D, Finneran S, Allen A, Maksut J.

Among a sample of Black and White MSM and transgender women, 63% reported awareness of PrEP with only 9% were reported use. There was an association between stigma belief (promiscuous) and lack of interest in PrEP. Among Black MSM and transgender women, conspiracy beliefs related to PrEP use was high.

Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women. Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S.

Women expressed interpersonal (e.g., partner assuming infidelity, intimate partner violence), clinical (e.g., inability to establish trust with providers), and structural (e.g., stigma related to taking ART, insurance coverage) barriers to PrEP use.

Women want Pre-Exposure Prophylaxis but are Advised Against it by Their HIV-positive Counterparts. Goparaju L, Experton LS, Praschan NC, Warren-Jeanpiere L, Young MA, Kassaye S.

Results support that both HIV-positive and negative women are unaware of PrEP. HIV-negative women expressed the need for PrEP publication and enthusiastic about potential use.

2018 8th HIV & Women Abstract 54: Knowledge and acceptability of HIV pre-exposure prophylaxis (PrEP) in pregnant women.  Richards R, Klemmer K, Salmoran F, Hull S, Fernandez S5, Hendrix C, Scott R

CROI 2018 Abstract Number 1045: Predictors of Willingness to Take PrEP Among Black and Latina Transgender Women. Tonia Poteat, Erin Cooney, Mannat Malik, Thespina Yamanis, Maren Lujan, Andrea L. Wirtz

Adherence 2017 Abstract Number OA269: “We need this!”  PrEP awareness and acceptability among women involved in the criminal justice system. Emily F. Dauria, Marina Tolou-Shams, Andrew Levine-Murray, Monique Lipman, Megan Comfort, Katerina Christopoulos

CROI 2018 Poster ID 1050 HIV Biomedical Prevention Among U.S. Women:  Knowledge, Beliefs, and Practices. Sebele Kassaye, Lakshmi Goparaju, Amanda Caste, Lari Warren-Jeanpierre, Anandi Sheth, Adaora Adimora, Margaret Fischl, Elizabeth T Golub, Kathleen Weber, Jennifer Cohen, Kemi Sosanya, Anna Rubtsova, Deborah Konkle-Parker, Tracey Wilson, Chenglong Liu

CROI 2018 Poster ID 1030: Assessing PrEP Needs Among Heterosexuals and People Who Inject Drugs, Washington, DC. Irene Kuo, Anya Agopian, Jenevieve Opoku, Anthony Rawls, Rudy Patrick, Manya Magnus, Michael Kharfen, Alan Greenberg

Adherence 2017 Abstract 343: PrEP Stigma and Perceived Disapproval by others may Deter PrEP Uptake among Women. Sarah Calabrese (presenting), Trace Kershaw, Abigail Caldwell, Susan Lane, Clair Kaplan,, Cara Safon, Rachel Galvao2 , Mehrit Tekeste.

Adherence 2017 Abstract 355: PrEP Use and Awareness among Transgender Women in South Florida. Cheryl Holder (presenting), Hector Perez- Gilbe, Elena Cyrus, Francisco Fajardo, Stephanie Garcia

Adherence 2017 Abstract 378: PrEP Awareness, Interest, and Use among Women of Color in New York City, 2016.  Anisha Gandhi (presenting), Emily Appel, Kathleen Scanlin, Julie Myers, Zoe Edelstein

Conception, Pregnancy & Breastfeeding

Consensus statement: Supporting Safer Conception and Pregnancy For Men And Women Living with and Affected by HIV. Matthews LT, Beyeza-Kashesya J, Cooke I, Davies N, Heffron R, Kaida A, Kinuthia J, Mmeje O, Semprini AE, Weber S.

A global group of scientist developed a consensus document addressing the need and demand for safer conception methods. Key questions are identified within the areas of demand, opportunities for prevention, and implementation for safer conception methods for HIV-positive and negative women and men.

Experiences Using Pre-Exposure Prophylaxis for Safer Conception Among HIV Serodiscordant Heterosexual Couples in the United States. Bazzi AR, Leech AA, Biancarelli DL, Sullivan M, Drainoni ML.

Serodiscordant expressed PrEP offers the opportunity for “natural” conception through condomless sex, and suggest increase awareness of PrEP for safe conception use as a mood to reduce HIV-related stigma.

2017 7th HIV & Women Abstract 58: Consensus statement: Supporting safer conception and pregnancy for men and women living with and affected by HIV. Matthews L, Beyeza-Kashesya J, Cooke I, Davies N, Heffron R, Kaida A, Kinuthia J, Mmeje O, Semprini A, Weber S, Safer Conception Consensus Guidelines Working Group

PrEP Efficacy & Effectiveness

Efficacy of oral pre-exposure prophylaxis (PrEP) for HIV among women with abnormal vaginal microbiota: a post-hoc analysis of the randomised, placebo-controlled Partners PrEP Study. Heffron R, McClelland RS, Balkus JE, Celum C, Cohen CR, Mugo N, Bukusi E, Donnell D, Lingappa J, Kiarie J, Fiedler T, Munch M, Fredricks DN, Baeten JM; Partners PrEP Study Team.

“Among African women with a high prevalence of bacterial vaginosis and high adherence to PrEP, the efficacy of daily oral PrEP for HIV prevention did not differ significantly among women with abnormal versus healthy vaginal microbiota as defined by Nugent score. These data are reassuring that oral PrEP delivery to women can continue without the need for concurrent testing for bacterial vaginosis or vaginal dysbiosis.”

Pre-exposure prophylaxis for HIV prevention in women: current perspectives. Flash CA, Dale SK, Krakower DS.

This is a review of efficacy data for HIV PrEP in women including barriers and facilitators to uptake among this population.

CROI 2017 Abstract Number 85: Daily Oral PrEP is Effective Among Women with Abnormal Vaginal Microbiota. Renee Heffron, R. Scott McClelland, Jennifer Balkus, Connie L. Celum, Craig Cohen, Nelly Mugo, Elizabeth A. Bukusi, Deborah J. Donnell, Jared Baeten

Drug-Drug Interaction

Pharmacologic Considerations for Preexposure Prophylaxis in Transgender Women. Anderson PL, Reirden D, Castillo-Mancilla J.

This review found that there are no interaction risks between feminizing hormone regimens and PrEP regimes, particularly tenofovir. However, the authors do call for a randomized control trial among transgender women to confirm review results.

Provider Knowledge, Attitudes & Beliefs

Integrating Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention Into Women’s Health Care in the United States. Seidman D, Weber S.

Seidman and Weber provide OB/GYN providers an expanded tool kit to guide their practice in shared decision making about HIV prevention, including PrEP among women at-risk for HIV.

Prescribing of Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis by HIV Medical Providers in the United States, 2013-2014. Weiser J, Garg S, Beer L, Skarbinski J.

Approximately 26% of medical providers reported prescribing PrEP. LGB and male providers were more likely to prescribe PrEP. Medical providers prescribed higher percentages of MSM compared to women who have sex with men.

Family planning providers’ role in offering PrEP to women. Seidman D, Weber S, Carlson K, Witt J.

Given that 40% of women will only seek reproductive care across their lifetime, offering PrEP in family planning setting is the optimal approach to increase uptake among this population. Many lessons learned among early adopters can inform family planning practice on the most effective ways to provider PrEP services to women: clinical (e.g., listen to women, shared decision making), structural (e.g., tailored interventions, train providers), and equity (inequities in PrEP uptake, increasing trust).

HIV Care Providers’ Intentions to Prescribe and Actual Prescription of Pre-Exposure Prophylaxis to At-Risk Adolescents and Adults. Mullins TLK, Zimet G, Lally M, Xu J, Thornton S, Kahn JA.

Clinicians have higher intentions of prescribing PrEP to adult MSM and transgender women compared to adolescent MSM and transgender women, as well as, adolescent and adult heterosexuals with multiple partners of unknown HIV status, heterosexuals with HIV-infected partners.

United States family planning providers’ knowledge of and attitudes towards preexposure prophylaxis for HIV prevention: a national survey. Seidman D, Carlson K, Weber S, Witt J, Kelly PJ.

Among a national sample of potential PrEP providers, about a third of providers could correctly define PrEP, select the correct HIV testing after an exposure, and could accurately express the efficacy of PrEP. Characteristics of providers who were knowledgeable about PrEP including practicing in the Northeast or West, aware of PrEP guidelines, providers rectal STI screening, and routinely tests patients for HIV.

Adherence 2017 Abstract 406: A Pre-Implementation Assessment: Disconnect between Black Women and their Providers on PrEP. Charlene Flash (presenting), Oluwatobi Adegboyega, Syundai Johnson, K. Rivet Amico, Jeffrey Cully,, Adaora Adimora, Kenneth Mayer, Thomas Giordano

Differentiated Approaches (Transgender)

The future of PrEP among transgender women: the critical role of gender affirmation in research and clinical practices. Sevelius JM, Deutsch MB, Grant R.

Article supports the need for PrEP trials focused solely on trans women to identify tailored intervention methods and techniques needed to increase PrEP uptake among this population. Key areas of concern are the availability of gender affirming providers and clinical environments, as well as, evidence to support PrEP does not interfere with feminizing hormone regimens.

Transgender Women in Clinical Trials of Pre-Exposure Prophylaxis. Grant RM, Sevelius JM, Guanira JV, Aguilar JV, Chariyalertsak S, Deutsch MB.

This study identifies limitations of combining MSM and transgender women in randomized control trials for PrEP. Transgender women are more likely to have transactional sex, more sexual partners, and lower detections of PrEP in blood compared to MSM in PrEP trials. In effort to increase PrEP uptake among transgender women there is a need to better investigate key issues among this population and offer tailored care including ” use of preferred pronouns and names, safety to use the bathroom of choice, and access to gender-affirming hormone therapy and surgery.”

Adherence 2017 Abstract 279: Transgender Women and Engagement in the Pre-Exposure Prophylaxis Continuum. Thomas Whitfield (presenting), Demetria Cain, H. Jonathon Rendina, Sitaji Gurung, Jeffrey Parsons

Differentiated Approaches

US Black Women and Human Immunodeficiency Virus Prevention: Time for New Approaches to Clinical Trials. Adimora AA, Cole SR, Eron JJ.

This article outlines the limitations of randomized control trials when working with populations at-risk for HIV, in particular Black women, and proposes use a name method to measure efficacy by “evaluating the relationship between HIV incidence and drug concentrations measured among participants in traditional phase 3 trials conducted in high-incidence settings, and then applying these observations to drug concentrations measured among individuals in lower-incidence settings.”

This bibliography was curated by Judith Auerbach, PhD and Brittany Chambers, PhD in collaboration with HIVE. While we have worked hard to include the work of many, we understand that this is not an exhaustive list but hope that it is informative. Thank you for your support of our work. If you have any questions, please contact Yamini at yamini@hiveonline.org