Why is PrEP uptake so low in women, and what can be done to change that? Niamh is a HIV Clinical Nurse Specialist (CNS) in Birmingham, and wanted to share her thoughts this HIV Testing Week.
Niamh Fleming-Kiełb – HIV Clinical Nurse Specialist – Birmingham
My name is Niamh, and I work as a HIV CNS in Birmingham. Recently, I conducted a small experiment among my friends and peers.
One evening I sent a text to 20 women asking “Did you know that women can access PrEP to reduce their risk of acquiring HIV?”.
Only three out of the twenty women were aware that women can use PrEP and that they are able to access it. One friend even remarked, “I always worried about pregnancy and STIs, but HIV never occurred to me”.
So why is this important and what is PrEP? PrEP (pre-exposure prophylaxis) is taken by people who are HIV negative but at risk of exposure to HIV. It is a pill containing two drugs that, when taken correctly, reduces your risk of getting HIV.
In 2020, the UK Health Secretary announced that PrEP would be available for free on the NHS— this was a key turning point in achieving the government’s target to end new HIV cases by 2030. But, whilst this is a fantastic step forward in reducing HIV transmission, the uptake, education, and lack of access for women remain low.
Women are less likely to use PrEP than men, even though they are at similar risk of acquiring HIV. This is a significant public health issue that needs to be addressed. Reasons for the disparity include: difficulty identifying women at highest HIV risk, low self-perception of HIV risk, low PrEP knowledge, as well as structural and individual barriers to PrEP initiation.
Women only represented 2.9% of attendees at specialist sexual health services who initiated or continued use of PrEP in England in 2022 – and in 2019, the overall prevalence rate for PrEP use among women was only 12 per 100,000. This is a jarring comparison to 75.4% of gay, bisexual, and other men who have sex with men who accessed and used PrEP during the same period.
We need to change the narrative of who, and who isn’t, a “low transmission risk”. Women have sex. Women are equally at risk of acquiring HIV.
The key to breaking the cycle is improving our relationship and Sex Education (RSE) in schools. Women and young girls are told repeatedly from a young age “don’t get pregnant”, but wider sexual health and HIV education— including PrEP and PEP— should be a key component of those ongoing conversations and teachings.
Women, we have the tools to protect you from HIV, protect your family from HIV, and be part of the generation that stops HIV. Let’s do it.
For more information about PrEP for women, check out this page from our friends at Team Prepster: https://prepster.info/prep4women
