Many women are unaware of HIV pre-exposure prophylaxis (PrEP) but show a keen interest in spreading the word once they learn about the option, according a recent study in the journal Contraception
"Essentially I think the biggest takeaway is that, historically, women in the United States, in particular women in the southern United States where the rate of HIV is high, are unaware of this prevention option that might be very appealing to them," Jessica M. Sales, PhD, associate professor at the Rollins School of Public Health and Emory University and an investigator on the study, told Contagion®
. "Once they learned about PrEP, they did find that it was an option that they felt really strongly that other women should know about."
The study included 500 women at 4 family planning clinics in Atlanta, and included an HIV risk screener before the patients visited with a provider, followed by questions about their counseling afterward.
According to the study, 18% of women surveyed knew about PrEP and 28% of the 376 who were sexually active had a risk indicator placing them within the recommended range for PrEP. Georgia ranks 3rd
highest for lifetime HIV risk, the study noted, adding that 56% of women diagnosed in 2015 were living in the south.
Prevention has focused largely on condom use, which women aren't always in control of, Dr. Sales pointed out.
"(PrEP is) a very empowering method that women should have access to and have information about," she said in the interview.
Family planning providers are important for scaling uptake of PrEP among women. Survey participants provided input for how they would like to learn about PrEP, with 150 participants suggesting that clinics distribute materials such as brochures, posters, and emails; 134 suggesting providers should speak directly with patients about PrEP; 71 saying information should be spread broadly in the community; and 11 wanting better access to PrEP.
"This idea of universal education about PrEP was something that participants really endorsed in this study," Dr. Sales told Contagion®
The next step is to ensure that clinics and providers have the resources and training to feel comfortable addressing PrEP with their patients. Dr. Sales said she and Anandi Sheth, MD, an assistant professor at Emory University School of Medicine, are launching a 2-year training and implementation study.
"They were very curious and very much interested in learning more about PrEP. That's very different than taking PrEP," Dr. Sales said in the interview. "I think we might see that there might be some stigma among women that might be a barrier to taking PrEP, similar to men."
Since PrEP was approved in 2012, a greater focus has been on promoting use of PrEP among men who have sex with men.
A gap remains between the number of people taking PrEP and those who meet the US Centers for Disease Control and Prevention's guidelines for those who should be considered to take it. A recent column in The New England Journal of Medicine
suggested that biases of providers
may contribute to the lag. The column offered 3 initiatives: updating guidelines to more broadly endorse PrEP, encourage more involvement of patients in discussing priorities, and training clinicians to recognize and minimize biases.
Another commentary published in The Lancet
suggested that changes to marketing messages
could help reduce the stigma surrounding PrEP by shifting the focus on PrEP to one of protection, widespread appropriateness and integrated services.
Young people who aren't in the habit of taking pills daily and adolescents who may not think they are at risk are among those who struggle with adherence to PrEP regimens
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