This article was originally published on December 1, 2015.
Three years ago, a little blue pill completely changed how I think about sex. (No, not that
blue pill.) Growing up during the ‘80s and ‘90s, I was taught that having sex with other men was a potentially deadly proposition. As I got older, medical advancements and my own experience proved that this was, thankfully, no longer true. But I’m nevertheless part of a generation of gay men for whom sex has always been inseparable from a deep-seated fear of HIV. In 2012, all that changed — and it was almost impossible to believe.
PrEP (pre-exposure prophylaxis) is a daily pill regimen that’s been proven to reduce the risk of HIV infection by up to 99%
when taken as directed. A combination of two existing antiretroviral drugs that have long been used in the treatment of HIV, PrEP was approved by the FDA in 2012 as an HIV prevention strategy. The results of a recent three-year study
in San Francisco found zero (!) incidents of HIV infection among a group of sexually active gay men taking PrEP. The drugs have no serious side effects, and their cost — about
$11,000 a year — is covered by most insurers.
In a few short years, the conversation about Truvada (the drug’s trade name) has evolved dramatically among gay men. Initially, some regarded PrEP with anxiety and skepticism, and early adopters faced slut-shaming
. For men who had long considered condoms a life-saving measure, any excuse not to wear them felt irresponsible and dangerous. (The CDC recommends
that men on PrEP continue to use condoms, and studies have found
an increase in other STDs among the drug’s users, underscoring this need.) Still, PrEP feels like a true game-changer: Even if they don’t use these pills themselves, most sexually active gay men are likely to have a number of friends who do.
And yet, when I bring up PrEP with a female friend, more often than not, she’s never heard of it. Considering what a tremendous impact this drug has had on the gay community (and the fact that my female friends are among the smartest people I know), I started asking myself, Why aren’t more women talking about PrEP?
When I posed this question to several experts, they pointed to a number of reasons. Obviously, pregnancy and contraception are top-of-mind concerns for the vast majority of women who have sex with men. But HIV also affects the female population in huge numbers: About one in four people living with HIV in the U.S. are women, according to the CDC
, and worldwide, the number is closer to half. “Particularly in the United States, it’s a challenge, because many people think of HIV still as very much a 'gay disease,' and that’s incorrect,” says Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition.
Who are the women who stand to benefit most from PrEP? Chances are, if you’re a sexually active woman, you understand what behaviors put you more at risk — such as having unprotected sex with multiple partners. It’s true that you can’t know everything about your sex partners (even a monogamous one). But if you’ve had no reason to worry about HIV before, you likely don’t need to run and ask your doctor about taking PrEP. That said, women who fall into certain demographics stand to benefit from this drug tremendously — if only they knew it existed and could comfortably connect with knowledgeable health care providers. One of its uses is truly astounding: A woman can take Truvada to have a child with an HIV-positive partner, preventing transmission of the virus both to herself and her baby.
PrEP holds enormous potential to be a boon for women’s health — not only by preventing infection, but by empowering women to assume control over their HIV risk, in the same way contraception lets women decide if and when they wish to become pregnant. Ahead are groups of women for whom PrEP could be especially life-changing.