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Improving PrEP Uptake in Cis Women
Changing the Status Quo: Maximizing Opportunities to Improve PrEP Uptake in Cisgender Women

Released: December 12, 2023

Meredith E. Clement
Meredith E. Clement, MD
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Key Takeaways
  • PrEP is safe and effective for use in cisgender women.
  • Having a conversation with your patients about PrEP is the first step to destigmatizing its use.
  • Healthcare professionals need to work together to raise PrEP awareness and ensure that patients feel informed and empowered to make their own decisions about their sexual health, including the use of PrEP.

Daily oral pre-exposure prophylaxis (PrEP) has been approved by the FDA in the United States for more than a decade, yet we still face challenges with use and adherence, particularly among cisgender women and racial and ethnic minority groups, such as Black and Hispanic populations.

In recent years, the medical literature has been overwhelmed with studies exploring the barriers to PrEP uptake, highlighting the lack of patient–provider communication, cost concerns, intimate partner violence, stigma, medical mistrust, and limited awareness and/or education about PrEP among those who could most benefit.

We as healthcare professionals (HCPs) need to turn the conversation around to discuss and pursue opportunities to enhance PrEP awareness, access, and uptake. Although some challenges are beyond our reach as HCPs, here are things we can do daily to improve the status quo.

Raise Awareness
Awareness is not just knowing what PrEP is—for many, particularly cisgender women, it is knowing that PrEP is meant for them, too. Unfortunately, many women have the misconception that PrEP is only for gay men or transgender women.

As an HCP, you can set the record straight that PrEP has been well-studied in cisgender women and has been deemed safe and effective for HIV prevention. Being knowledgeable about the various PrEP options helps build awareness. Daily or on-demand pills or even bimonthly injections could be right for your patient, depending on the type of sex they are having. It is likely that, as more PrEP options are offered, more people will become interested and engaged in care. To date, 2 PrEP regimens are recommended for those having receptive vaginal sex (daily oral emtricitabine/tenofovir disoproxil fumarate or injectable cabotegravir every 2 months), but my hope is that these options will expand as more data become available.

Enhance Communication
Initiate the conversation about PrEP with your patients and make sure other HCPs around you are doing this, as well. Your patients may want time to think about whether PrEP initiation is right for them, and that is okay—in fact, it is encouraged.

Your goal should be to inform and empower your patients to make their own decisions about their sexual health, and starting the conversation about PrEP is the first step. Spreading the word to other HCPs by encouraging them or offering clinical guidance to make sure they feel competent to have the discussion and write a prescription is also valuable.

Our institution has initiated PrEP training programs for primary care and gynecology providers to expand our reach. This may be something your center or clinic could take on, too.

Combat Stigma
PrEP commercials and signage should feature people from all racial and ethnic minority populations and all sex, gender, and sexual identifies to show that PrEP is for all. Make sure your clinic has inclusive brochures and signs hanging in areas that are visible to patients. 

Navigational services may help. A recent study highlighted the importance of peer navigators to destigmatize and normalize PrEP use and enhance self-efficacy.

Finally, creating a “sex-positive” environment and de-emphasizing risk or “risky” behaviors is critical. In our clinic, we focus more on community risk (eg, we live in a highly HIV prevalent area) than individual risk, discussing why many people who are sexually active in our area could benefit from PrEP. 

Current and Future Opportunities
Numerous daily opportunities are well within our reach to promote PrEP use, such as normalizing PrEP conversations with our patients. However, it is important to consider further growth and opportunities. I encourage you to consider creating training programs or incorporating navigational services at your practice site. Implementing these ideas and programs will go a long way toward overcoming PrEP barriers faced by our patients.

Your Thoughts?
How do you initiate the conversation about PrEP use among cisgender women in your healthcare setting? Join the discussion by posting a comment.