Improving HIV Prevention and Health Outcomes for Women and Girls as We Work to End the HIV Epidemic

Women and girls play a central role in the health of their families and communities.  This role is important for HIV/AIDS prevention; yet the risk for women and girls is sometimes overshadowed.  On March 10th, we observe this year’s National Women and Girls HIV/AIDS Awareness Day to encourage women and girls to make HIV testing, prevention, and treatment part of their self-care, as well as the care of others in their families and communities.

Although we have made considerable progress for women and girls, HIV significantly impacts Black women and transgender women in the United States. Black women accounted for the largest share of HIV diagnoses among women in the U.S. in 2018 (57% of nearly 7,200 new diagnoses). Additionally, an estimated 14% of transgender women in the United States have HIV. For both groups of women some barriers including stigma, medical mistrust, intimate partner violence, and societal beliefs around cisgender and transgender women’s health continue to drive inequities in HIV prevention and care. It is critical to address these challenges while continuing to reinforce the importance of HIV testing. This is the first step to both prevention as well as treatment and care.

It is also critical to advance policies and services that are tailored to the needs of women at the federal, state and local levels. This is especially vital for Black and transgender women to improve their health outcomes, prevent new infections, and achieve our collective HIV goals. During the 70th Presidential Advisory Council on HIV/AIDS Meeting earlier this week, a panel focused on the importance of HIV testing for women, as well as how to address internalized and societal stigma.

One of the greatest opportunities for HIV prevention in women is routine HIV testing. CDC recommends routine HIV testing for everyone ages 13-64 and repeat testing at least annually for those who are at high risk for HIV infection. Yet, women and girls often do not see themselves at risk or may be apprehensive to proactively seek testing due to stigma and fear. Additionally, health care providers do not consistently talk to women about their sexual health during health care visits or offer them an HIV test. Knowing your status via testing should be a routine part of a health care visit, like getting your cholesterol or blood pressure checked.

For women who are at risk for HIV, there are tools available that prevent transmission. Daily oral PrEP medication is a safe and highly effective HIV prevention strategy which can be used during pre-conception, pregnancy, and breastfeeding. Yet in 2018, only 7% of women with indications for PrEP received a prescription, as compared to 21% of males. PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed, and should be used along with condoms to prevent other sexually transmitted infections and pregnancy. For women who think they have been exposed to HIV (during sex or if they have been sexually assaulted), PEP medication can also prevent HIV if taken within 72 hours at the direction of a health care provider, emergency room doctor, or urgent care provider.

For women living with HIV, getting into care and treatment after knowing your positive status is critical to achieving and maintaining an undetectable viral load (the amount of HIV in the blood) by taking antiretroviral therapy (ART). When taken daily as prescribed, women can live long, healthy lives. Another benefit of ART is that it helps prevent transmission to sexual partners or during syringe sharing; and from mother-to-child during pregnancy, birth, and breastfeeding. HIV community members, advocates, and experts often refer to this as “Undetectable Equals Untransmittable” or “U=U”.

There are several steps we can take to help end the HIV epidemic. The first is to take care of ourselves. Get tested to know your status and either use prevention tools such as PrEP and condoms or seek treatment, if appropriate. Next, listen to those with and at risk for HIV, as they express their lived experiences or challenges they face accessing prevention, treatment, and care services.

We can also use available HIV testing and prevention tools; and help spread the word about them with our family, friends, and networks. HIV self-testing is a highly effective option during these times of social distancing when it may be difficult to access traditional places where HIV testing and care are provided. Assistance programs such as Ready, Set, PrEP provide free PrEP for those without prescription drug coverage.

I want to tell all the women and girls out there that you are not alone. You are worth it and I encourage you to empower yourself to take control of your own health and well-being. On National Women and Girls HIV/AIDS Awareness Day, we honor those who inspire us with their resilience in the face of numerous barriers and motivate us with their strong leadership. I am honored and humbled to know and work with such strong, smart and resourceful women and girls.  I am confident that we will end the HIV epidemic by working together.  Our power is listening, learning, leveraging, loving and living in our truth.