Implementing pre-exposure prophylaxis for HIV prevention in women: the role of the obstetrician-gynecologist

HIV Prevention and Sexual Health Conversations Among Women in Ending the HIV Epidemic Priority Communities: A Qualitative Exploration of Experiences and Preferences

Despite significant advances in HIV prevention, women comprise ~ 20% of new HIV infections in the USA. New infections occur primarily in the South and among Black women, with research demonstrating that insufficient knowledge, inaccurate risk assessment, and HIV stigma impair HIV prevention. Understanding how cisgender women wish to communicate about sexual health and HIV prevention is vital to facilitating conversations about, and subsequent uptake of prevention methods. A total of 70 individuals who lived or worked in four HIV prevention priority counties in the state of Georgia were recruited through community-based organizations (CBOs) and flyers. Consenting participants completed 30-45-min interviews. Interviews were transcribed verbatim; transcripts were coded deductively and inductively. Participants were primarily female-identifying (91%) and were primarily Black. Overall, participants noted that community-level conversations about sexual health among women were limited due to stigma, despite endorsed comfort with conversations. Participants noted that media/community sources implied HIV prevention was unneeded for cisgender women. CBOs and informed community members were endorsed as trusted sources for information; clinicians were cited as a theoretically trusted source, particularly sexual health preventative care providers with established patient relationships, though barriers of medical mistrust, lack of cultural concordance, and stigma were noted. Suggestions for improved communication around HIV prevention included use of community members/trusted sources to facilitate conversation, promotion of non-judgment in clinical practice, and prevention awareness building. Participants' responses suggest little-to-no movement in knowledge of HIV prevention for US women. Engagement of CBOs in community education, training of community leaders, and integration of trauma-informed and patient-empowering clinical practices should be explored to promote increased HIV prevention discussion and uptake among cisgender women in the US South.

"PrEPping" women's healthcare providers: motivational interviewing to support ending the HIV epidemic

In 2018, cisgender women accounted for nearly 20% of new HIV infections, with women of color disproportionately affected. HIV pre-exposure prophylaxis uptake, adherence, and persistence are paramount to ending the HIV epidemic, but current strategies to promote it have not improved uptake among women. Alternatively, pre-exposure prophylaxis marketing and implementation have traditionally targeted men who have sex with men and transwomen. Women feel most comfortable turning to their primary care and reproductive health providers for HIV and pre-exposure prophylaxis counseling, but prescribing is the lowest among these providers. Thus, reframing pre-exposure prophylaxis counseling and education strategies is crucial to better engage providers and patients. Motivational interviewing is a person-centered counseling style for eliciting behavior change. Providers use 4 core skills-open-ended questions, affirmation, reflective listening, and summarizing-to empower individuals for behavior change, such as pre-exposure prophylaxis use. Motivational interviewing is brief, individualized, and effective in increasing pre-exposure prophylaxis uptake, regardless of patients' readiness to change. Primary care and reproductive health providers can employ motivational interviewing approaches with pre-exposure prophylaxis counseling to increase uptake among cisgender women and end the HIV epidemic.

Women's perspectives on barriers to potential PrEP uptake for HIV prevention: HIV risk assessment, relationship dynamics and stigma

HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed.