HIV Prevention Tools for Women and Transgender Men: Opportunities and Challenges
April 13, 2016
In two recent online discussions on HIV prevention, providers and advocates discussed reproductive health, promising research on new methods and the importance of destigmatization in extending PrEP and other prevention options to women (including transgender and pregnant women) as well as transgender men.
A vaginal ring that showed promising results in a proof-of-concept study reported at the 23rd Conference on Retroviruses and Opportunistic Infections (CROI) is the most talked-about option at this point, noted members of the U.S. Women & PrEP Working Group in a recent webinar.
Another trial, HPTN 067 (ADAPT), is looking at various dosing options for tenofovir/emtricitabine (Truvada) when taken for HIV prevention rather than treatment. It found that women were more likely to take the medication as prescribed when they had to take it once a day rather than less frequently. In a recent Google Hangout sponsored by HIVE, Caitlin Conyngham of Philadelphia FIGHT pointed out that women could apply the strategies they use to remember their birth control pill every day to taking their PrEP pill.
HIV prevention cannot be separated from women's reproductive intentions, Dominika Seidman, M.D., of the University of California, San Francisco, cautioned in the webinar, especially when women discontinue condom use in order to conceive. Since about half of women access the health care system only through their family planning provider, such providers need to discuss HIV prevention with their patients, she said. However, her survey of 342 potential PrEP prescribers showed poor knowledge about PrEP among providers, but great interest among them (87%) in receiving more training on the topic.
Traditional women's health services also need to be expanded to include transgender people, webinar participants noted. To that end, gynecology clinics must become more welcoming to transgender men, Dr. Seidman said. Her family planning clinic also provides surgical services to transgender persons and uses that opportunity to talk about HIV prevention and the potential for PrEP. Providers also should not make assumptions about trans men's reproductive intentions, she emphasized. Moreover, conversations about such intentions provide an opportunity to discuss HIV prevention and PrEP with people who may not otherwise access health care services.
Pregnant women pose a special challenge, particularly in locations with a high seroprevalence rate, such as the South Bronx in New York City where Bronx Lebanon Hospital is located. Maria Teresa Timoney, C.N.M., explained that specific cases at the hospital had led to the incorporation of questions about a partner's HIV status into routine medical forms at the prenatal clinic. Even if a woman's own HIV test is negative, if she reports a partner living with HIV, then she meets with a community educator at the clinic who may refer her to Bronx Lebanon's infectious diseases clinic for further screening for PrEP.
However, few assessment tools for identifying women who might benefit from PrEP exist, Karen Hoover, M.D., M.P.H., of the Centers for Disease Control and Prevention noted. Unfortunately, there is little women-specific PrEP data to allow development of such tools, she said. That may not be necessary if PrEP is discussed with every patient, regardless of HIV risk, which is the practice at Caitlin Conyngham's Philadelphia clinic, the Y-HEP Health Center. This approach removes the stigma associated with "high-risk sexual behavior" and similar phrasing and so helps to build trust between patient and provider, she explained.
Such trust and destigmatization are crucial for ensuring that women will consider taking PrEP, participants in the two online events agreed. However, most messaging around this form of HIV prevention is geared towards men who have sex with men rather than women, Dr. Hoover pointed out. As a result, women don't know to ask for PrEP, as Marsha Jones of the Afiya Center in Dallas, Texas, noted. Nonetheless, the few providers who prescribe PrEP in her county only offer it to women "if they ask," she said. There are also no PrEP screening criteria related to intimate partner violence, even though fear of such violence may prevent women from using condoms.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
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