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HIV PrEP for Cisgender Women
I Got All My Cis-ters With Me: PrEP Access and Uptake Among Cisgender Women

Released: June 26, 2023

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Key Takeaways
  • Given that current pre-exposure prophylaxis (PrEP) management protocols require visits to a healthcare professional (HCP) every 3 months, I’ve run into problems with finding HCPs willing to manage my PrEP prescription.
  • HCPs should initiate discussions about PrEP for HIV prevention as part of their current conversations about birth control and sexual health resources in cisgender women.

I take my active and healthy dating life seriously. Like other cisgender women who’ve connected with the TV characters Blanche Devereaux (The Golden Girls), Samantha Jones (Sex and the City), and Sasha Snow (Sex/Life), I’m always thinking about ways to keep the fun going safely. But as a single Black woman, I haven’t always felt I had access to the full range of biomedical prevention techniques to make this possible. It wasn’t until 2018, when I obtained my first pre-exposure prophylaxis (PrEP) prescription, that I felt more fully prepared to engage in a healthy sex life.

Barriers and Challenges 
Despite seriously dating people who were HIV positive since 2017, I felt defeated in seeking PrEP. I arrived at my doctor’s offices armed with knowledge and information that I obtained from the internet and my friends in HIV/AIDS research and care. The women’s clinic I visited proclaimed, “We don’t do that here,” and then referred me to the only other doctor in the broader practice who had ever written prescriptions for PrEP. There, this new doctor told me I became the first woman for whom she had fulfilled a PrEP request. Although a lot has changed in the past 5 years, this story is not mine alone.

One of 9 women is unaware of her HIV status. Black women represent 58% of more than 245,000 women living with HIV in the United States. Although it is believed that 10% to 20% of women in the US are aware of PrEP, PrEP initiation and uptake are significantly lower in women than in men—especially among Black women, despite their increased risk for acquiring HIV. Part of the challenge with Black women’s PrEP uptake is clear in my own story: lack of access to information and being unwilling and/or poorly prepared to engage with healthcare professionals (HCPs). 

Future Opportunities 
Since 2018, I have been on and off PrEP multiple times because I move often. Given that current PrEP management protocols require visits to an HCP every 3 months, I’ve run into problems with finding HCPs willing to manage my PrEP prescription. 

Last year, I moved to Vermont and had a 6-month wait time for a new primary care physician. I finally saw a gynecologist, and their office noted they would not take on my PrEP request because the monitoring protocol would be too much of a burden. 

Based on my experiences, I have a couple of ideas on how to improve PrEP uptake among cis women.

  • HCPs shouldn’t wait for cis women to ask about PrEP or continue treating PrEP as if it is only for men who have sex with men. Instead, HCPs must begin to include discussions about PrEP for HIV prevention as part of their current conversations about birth control and sexual health resources. HCPs should not be nervous about recommending PrEP as another biomedical intervention in cis women’s broader health tool kits.
  • I had to learn about PrEP from professionals in the field. Not every cis woman is privileged to have that same kind of access. For this reason, commercials, social media campaigns, and other marketing tactics that have shown promise in other women’s health campaigns should be applied to cis women and PrEP. They should especially target Black cis women, given our increased risk of HIV/AIDS.

We all have a social and moral obligation to help cis women understand their access to PrEP and doing so has never been more critical.

Your Thoughts?  
How can you promote PrEP access and uptake among your cisgender women patients? Join the discussion by posting a comment.