By Sabrina Rewald
Reproductive Justice Fellow, SisterLove Inc.
Empowering women in intimate relationships is a key step, and too often overlooked, in the fight against HIV and AIDS. Women need to be educated about preventative options that don’t require them to rely on their partner for compliance. We want to inspire an HIV prevention revolution to empower women with treatment options and shed the stigma around living with HIV.
To start, women need to be educated about PrEP. PrEP (Pre-exposure Prophylaxis) is a pill that is taken orally every day, acting as a significant barrier for serodiscordant couples. In other words, a person without HIV is more protected from exposure a sexual partner with HIV by taking this pill. PrEP does not provide 100% protection and should be used with condoms. If taken consistently, however, studies have shown individuals on PrEP have a 92% reduced risk of infection.
In the face of violence from an intimate partner, a woman’s ability to negotiate use of condoms may be compromised. For women exposed to IPV or who have limited ability to negotiate for condom use for other reasons, access to PrEP can provide protection from exposure to HIV that they may need. It may be taken discreetly, and while it does not provide complete protection it has the potential to reduce the dependency on a woman’s partner to agree to wear a condom.
PrEP was approved by the FDA in 2012, and the combination pill (named Truvada) was approved in 2004, yet still today women are not being adequately educated about PrEP as a preventative option. Dazon Dixon Diallo, President and Founder of SisterLove, Inc. recently explained in an interview with Fred Schaich of IFARA that for so many women, when they are informed of PrEP through SisterLove’s support groups and educational programs for women living with HIV, their first reaction is anger. “Why didn’t I know this?” Women want to know why this information is being kept from them, and they want access. The fact is, there is not enough information available to women about prevention and this needs to change.
Prevention methods that can strengthen women’s bodily autonomy don’t stop at PrEP. Microbicides are gels or films than can be applied rectally or vaginally to prevent sexual transmission of HIV, however no microbicides have been approved yet for public use. In fact, it may be a number of years before microbicides are available to the public. Once approved, microbicides have the potential to provide women with the control over their bodies that may be missing with regular condom use. Until then though, we need increased research efforts and public education on microbicides.
Finally, effective HIV treatment is HIV prevention. HIV treatment still isn’t a priority across the nation and this needs to change.
Georgia is an example of a state, ranked fifth in the US for HIV prevalence, where the lack of access to treatment or inability to adhere to treatment for many people living with HIV significantly hampers prevention efforts. Georgia has yet to expand Medicaid and over 20% of the population remains uninsured. People of color are most impacted by the epidemic in Georgia and black women are uniquely impacted, constituting 75% of all women living with HIV in the state. The majority of people living with HIV are located in Metro Atlanta, where black women have an acquisition rate of HIV that is 14 times that of white women.
In looking at an example of how treatment can be prevention, San Francisco had new cases of HIV drop to just 300 last year through the city’s immediate linkage to care program, including patient tracking programs supporting adherence for newly diagnosed people who might otherwise have difficulty adhering to medication. Success stories such as San Francisco’s this year can help to promote the fact that when it comes to HIV, treatment is prevention.
This epidemic can end in the U.S. We need more information on approved medications like PrEP, future opportunities in microbicides, and success models for using treatment as prevention. We need women to be informed and have access to new methods and medication that don’t require them to rely on a partner for protection. We need to focus on supporting women’s bodily autonomy. We need a prevention revolution.