Women’s group discuss PrEP

In the first eight months that PrEP was available on the NHS in Scotland, only 10 out of 1,295 people to access the HIV prevention drug were women.

Our women’s group in Edinburgh recently met up with Dr Ingrid Young of Edinburgh University, as part of research work to understand the barriers that women face accessing PrEP, and how this access could be widened.

One of the key issues that came out of the discussion was concern that PrEP wasn’t seen as something for women. The group didn’t know a lot about the drug, and the information they did have was generally targeted at gay and bisexual men at high risk of HIV.

The group highlighted examples where PrEP could bring real benefits for women, and some of the different barriers that are preventing that from happening. One particular concern was that decisions on PrEP are focused on clinical factors, without consideration of the real-world social issues that surround sex and relationships.

For example, the current guidelines would prevent a woman from accessing PrEP if her partner was living with HIV and had an undetectable viral load. While a person living with HIV who is undetectable cannot pass the virus on to a partner, this message is not widely understood. In such cases, partners may not believe they can’t pass on HIV, placing stress and anxiety on sexual relationships and discussions around starting a family. A more socially aware approach to PrEP could help to alleviate these challenges.

In another example, some of our African service users in particular have highlighted the challenges around negotiating condom use in sex with their partners. PrEP would offer another way for women to take control of their HIV status, alongside regular testing for other STIs.

Something that came across very clearly in the discussion was the lack of women-specific information and support. Stigma around HIV and sexual health can sometimes make it difficult for women to access general services. There is more to be done to ensure that women are aware of dedicated sexual health clinics for them, and that information is available that talks specifically about the options for women.

The feedback from the day is being fed into wider discussions around women and PrEP. This includes a roundtable discussion taking place later this month, organised by Dr Young’s Developing HIV Literacy Project, PrEPster and HIV Scotland. Waverley Care is joining that discussion and we’re looking forward to a productive meeting.

Although there is a need for work to widen access to PrEP, it is also important to recognise that initial figures on its uptake are encouraging. The vast majority of people to access PrEP have been gay and bisexual men, a community that is disproportionately affected by HIV linked to a range of health and social inequalities. The initial figures suggest that awareness of PrEP has encouraged more men to access sexual health services for the first time in years, which can only be a good thing.

Alongside this success, it is important to look at ways to widen access, so that anyone at high risk of HIV can access PrEP, and we’ll continue to be involved in discussions about how this can be achieved.