PrEP for Women
The PrEP Debate
While many HIV advocates believe that Truvada as PrEP is a good addition to the prevention toolbox, some people disagree.
Just as adherence is a factor for people living with HIV, there are concerns that HIV-negative people may not adhere to the drugs and therefore PrEP will not be effective.
There are also concerns that HIV-negative people will use PrEP in place of condoms or other safer sex measures. Although PrEP is designed to be used in addition to condoms or other safer sex measures, one of the benefits of PrEP is that it can be taken without the agreement or knowledge of one's sex partner. Since condoms, when used properly, are more effective and less expensive than PrEP in preventing HIV, some believe that the approval of Truvada as PrEP may have a negative effect on these prevention efforts, and lead to additional HIV infections.
Some women asked about the possibility of using PrEP have expressed concerns about possible side effects. The studies of Truvada as PrEP have found that the most common side effects were nausea and vomiting. These side effects often occur among people taking a new HIV drug and often go away after a few weeks. While no serious side effects were found during the studies, Truvada can occasionally cause serious effects, including kidney problems, liver problems, lactic acidosis, lipodystrophy, and bone problems. In addition, the long-term effects of many HIV drugs are not well understood, especially for those who are HIV-negative. Therefore, it is important to weigh the benefits of preventing HIV infection against the possibility of side effects from Truvada when considering whether to take Truvada as PrEP.
In addition, if HIV-negative people taking PrEP become HIV+, do not know it, and continue to take Truvada, there is the possibility that their HIV will become resistant to Truvada and other similar HIV drugs. This not only can reduce treatment options for the individuals who become HIV+, but also can have serious consequences for public health, as Truvada-resistant HIV could then be spread to others.
Given the results of the FemPrEP study, it is clear that there is more to learn about the effectiveness of Truvada as PrEP in women. Some people believe we have enough knowledge to go ahead and begin using PrEP now, while others think we should wait until we have more proof that it is effective for women.
What Does PrEP Mean for Women at High Risk of HIV?
While we now have evidence that PrEP works in preventing HIV if the drugs are taken as prescribed, much more work needs to be done before PrEP becomes widely used and accepted. This includes improving health care systems so that people can access PrEP and making HIV testing more widely available, since only people who know they are HIV-negative can use PrEP safely. If people use PrEP when they are already HIV+, they are much more likely to develop drug-resistant HIV, which they may then pass on to others. Having drug-resistant virus can also make it harder to treat HIV infection. (See The Well Project's info sheet on Resistance.)
PrEP is a promising tool that women can use to prevent HIV infection without their partners' cooperation. However, many questions remain. How will taking PrEP affect pregnancy and breastfeeding? How will women get HIV testing, especially if their partners refuse to get tested? Will they be able to get PrEP if they do not know their partners' HIV status? Will a man be more likely to refuse to use a condom if he knows his partner is taking PrEP? Will women be able to keep the PrEP drugs given to them? Some women worry that the drugs given to them might be taken away and given to another family member who is viewed as "needing them more." These and other questions are currently being explored in both research and advocacy efforts in the US and globally.
Considering Taking Truvada as PrEP?
If you think PrEP may be a good option for you, here are a few questions you may want to talk over with your health care provider:
- How often -- and for how long (i.e., days, weeks) -- do I need to take PrEP if I am trying to protect myself from HIV? What happens if I miss a dose or several doses?
- What are Truvada's likely side effects and how will I manage them?
- How often will I need to be tested for HIV?
- How much will the drug cost me? Will it be covered by my insurance? Will the HIV tests also be covered by my insurance?
- Do any of my current medical conditions make Truvada a less-good choice for my health overall?
- Do any of my other prescription medications, over-the-counter drugs, street drugs, herbs, vitamins, or supplements have interactions with Truvada?
- What should I do if I become pregnant while on PrEP?
You may also want to discuss the pros and cons of taking Truvada as PrEP compared to using condoms or other safer sex techniques to reduce the risk of getting HIV. While PrEP is designed to be used in combination with condoms or other safer sex measures, women who cannot or do not use condoms may want to use PrEP in place of condoms. It is important to understand the overall risks and benefits of using PrEP to reduce one's HIV risk, as well as to consider methods of protection from other sexually transmitted diseases.
Adapted and updated from "PrEP: What Does It Mean for Women?" with permission from Global Campaign for Microbicides and AIDS United.
The Women's Collective Releases Toolkit for Advancing the Sexual and Reproductive Health of Women Living With HIV/AIDS
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