While men who have sex with men (MSM) account for the largest percentage of new HIV diagnoses in Queensland every year, the number of women being diagnosed is also increasing. Between 2000 and 2010 in Australia, the number of females living with HIV increased by 104.8%, men on the other hand increased by only 44.7%. Increases in female transmissions continue to climb with expectations that female transmissions will further increase by 58.6%, compared to only 33.7% for males between 2010 and 20201.
With these expected increases, the need for health promotion messaging towards women at risk is more important than ever, and equitable access to information is a must. Health services working with women need to have this information on hand, however with large populations living outside of the metropolitan area, getting information to the regions can sometimes be challenging. Mapping studies of HIV within Australia have shown that women living with HIV are more likely to live outside of the capital city and therefore have more difficulty in accessing health promotion information1.
One particular prevention strategy to be gaining momentum currently is PrEP – Pre-Exposure Prophylaxis. PrEP is similar to the contraceptive pill, in that it is taken daily by an HIV negative person as a preventative measure. The pill is a combination antiretroviral treatment (CART) – the same that many people living with HIV (PLHIV) take to manage the virus. International trials have shown that a dosage of four or more pills per week can reduce a person’s risk of HIV transmission by no less than 96%; with daily dosing potentially providing up to a 99% chance of remaining HIV negative2. While PrEP is not currently available in Australia, a trial is planned for Queensland before the new year. This trial will only be open to gay men and other MSM and therefore women will not have access at this stage. Focusing on MSM in the trial stage makes sense, after all, MSM are at a higher risk, however PrEP can become a key prevention strategy for many women and therefore everyone needs to be aware of their options, regardless of gender.
International research has shown that women have often been missed in awareness-raising of PrEP. However, more recent qualitative research has shown that women who consider themselves at risk of HIV have showed interest in access to PrEP.
PrEP can be seen not only as an HIV prevention method, but a tool of empowerment and safety, particularly for women at a higher risk of HIV transmission, namely sex workers and women in relationships with sexual violence. In areas where gender based sexual violence is high, PrEP can be used by women as a protection against HIV transmission; one that she has control of. Sexual perpetrators are unlikely to use condoms and PrEP will lower the risk of HIV transmission in these situations. In Sub-Saharan Africa, where women are at a higher risk of HIV transmission and gender-based violence, PrEP is an ideal prevention method.
Women in sero-discordant couples, where their male partner is living with HIV are also showing interest in access to PrEP in order to lower the risk of HIV transmission and have the ability to conceive children naturally3. Currently in the United States of America, where PrEP has been approved since 2012, 48% of scripts are filled for women4.
There has been some debate about the efficacy of PrEP in women due to earlier African studies (FEM-PREP and VOICE) which showed very low benefit of PrEP. However these results are due to low adherence of the medication and absolutely no relevance with gender. While many women living in developed countries are comfortable taking daily medication (like the contraceptive pill), oral medication is less common in developing countries and adherence therefore had a significant impact on trials in these countries.
For more information on any of these topics, go to www.qpp.org.au/prevention or contact the Community HIV Education and Prevention Program from a land-line, toll-free on 1800 636 241 or 07 3013 5550.
Wilson, David et al. Mapping HIV Outcomes: Geographical and clinical forecasts of numbers of people living with HIV in Australia. Accessed at: https://kirby.unsw.edu.au/sites/default/files/hiv/attachment/FinalModHIVoutcomes AusRep.pdf
2. Anderson, PL et al. Emtricitabine-Tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine 2012; 4(151) 151ra125. Accessed at: http:/stm.sciencemag.org/content/4/151/151ra125.abstract
3. O’Neal, Reilly. Women and PrEP: A Q&A with Dr. Judy Auerbach. Access at: http://betablog.org/women-and-prep-qa-judy-auerbach/
4. Mascolini, Mark. 53rd ICAAC Interscience Conference on Antimicrobial Agents and Chemotherapy September 10-13, 2013, Denver CO. Accessed at: http://www.natap.org/2013/ICAAC/ICAAC_04.htm