PrEPared to Fight: A Woman-Centered Approach to HIV Prevention
June 18, 2014
In 2000, Poppy Hillsborough* entered an office at San Francisco General Hospital with babies on her mind. Her boyfriend, Ted Morgan,* has HIV, and she wanted to know if she could have children with him without adopting or using expensive reproductive technology. If she thought of HIV medications at all, it was because they were keeping Morgan healthy. As far as Hillsborough was concerned, babies and meds were two different issues.
Until they weren't.
It took a decade and lots of false starts, but in 2010, Hillsborough and Morgan, now married, started trying for a baby. Once a month when Hillsborough was ovulating, the couple would leave the condoms aside and have sex once. They did it off and on for months, all with the hope, Hillsborough said, that she could have a baby with the sandy blond hair and lanky build of her husband. What made their experiment possible was a medication, Truvada, that Hillsborough took daily and that promised to reduce her risk of contracting HIV.
The fact that it was an HIV medication didn't seem real to her -- at least not until her husband started taking it to manage his virus, as well.
"All of a sudden, it was very clear that this was an HIV treatment medication," she said. "It made the risk we were taking feel very real. Up until then, it had felt kind of hypothetical. I realized, 'If I do get infected, this is what I might be taking.'"
Hillsborough was an early pioneer in a prevention method called pre-exposure prophylaxis, or PrEP. At the time she used it in 2010, the Food and Drug Administration had not yet approved Truvada for the purpose and she had a hard time getting doctors to prescribe it for her. After the FDA's approval in 2012, PrEP use increased more than eight-fold, going from about 150 users in 2011 to 1,274 users the following year. And nearly half of those users, 48 percent, were women.
That number surprised some, considering that the majority of the conversation about PrEP to that point had been conducted within and between members of the gay community. But it turned out that there was another group waiting to use it: women, many of them in relationships with HIV-positive men, who wanted to conceive safely or simply reduce their risk of contracting the virus. The surprising interest women showed in PrEP underlines the lack of control women have had over their sexual health in the past, said Dr. Gina Brown, an ob-gyn and a medical officer in the National Institutes of Health's Office of AIDS Research.
"Before PrEP there were no real options for women, in the sense that when we talked about prevention options before, the message was always, 'Use a condom,'" said Brown, who manages planning for studies of women and girls HIV treatment and risk. "But women don't use condoms; men do. And even female condoms require cooperation from men."
Indeed, whether PrEP is used for conception, as prevention soon after the man is diagnosed, or at other points in a couple's life cycle, PrEP puts the power of prevention in women's hands.
* Hillsborough and Morgan asked that we not use their real names.
This excerpt was cross-posted with the permission of BETAblog.org. Read the full article.
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