What unique challenges do women face in preventing HIV?

According to the Centers for Disease Control and Prevention, some prevention challenges are unique to women:

• Women can pass HIV to their babies during pregnancy and birth and through breastfeeding.
• A woman’s anatomy makes it easier to get HIV through sex compared with a man’s anatomy.
• Having a sexually transmitted infection (STI) raises a woman’s risk for HIV more than a man’s.
• Women are more likely to lack control in relationships and fear violence, stigma, or abandonment when trying to prevent HIV exposure.
• Women are more likely to be victims of sexual abuse. People with a history of sexual abuse are more likely to engage in high-risk sexual behaviors like exchanging sex for drugs, having multiple partners, or having sex with a partner who is physically abusive when asked to use a condom.

How can I prevent HIV?

The best way to prevent HIV is to not have vaginal, oral, or anal sex or share needles at any time. Sharing needles for any reason is very risky.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Male latex condoms are the most effective way to prevent HIV and other STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Female condoms can also help to prevent HIV infection. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
• Get tested. Be sure you and your partner are tested for HIV and other STIs. Talk to each other about the test results before you have sex. Having an STI increases your chances of becoming infected with HIV during sex. If your partner has an STI in addition to HIV, that also increases your risk of HIV infection. If you have an STI, you should also get tested for HIV.
• Be monogamous. Having sex with just one partner can lower your risk for HIV and other STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
• Limit your number of sexual partners. Your risk of getting HIV and other STIs goes up with the number of partners you have.
• Get vaccinated. You can get a vaccine to protect against HPV and hepatitis B, which are STI’s. There is no vaccine to prevent or treat HIV.
• Don’t douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting HIV and other STIs.
• Do not abuse alcohol or drugs. Alcohol or drug abuse may lead to risky behaviors such as sharing needles to inject drugs or not using a condom when you have sex.

The steps work best when used together. No single step can protect you from every single type of STI.

Male latex condoms are a highly effective way to prevent HIV and other STIs, but almost one in every five women who uses only condoms for birth control gets pregnant. The best way to prevent both STIs and pregnancy is to use a latex condom along with another highly effective method of birth control such as an intrauterine device (IUD), an implant, or the shot.

Can I take medicine to prevent getting or passing HIV?

Yes. Several medicines are available to help lower your risk of getting or passing HIV:

Pre-exposure prophylaxis (PrEP)

PrEP is an HIV prevention method for people who do not have HIV infection but who may be at high risk. PrEP is a pill you take by mouth every day.

Talk to your doctor about PrEP if:

• You are HIV-negative but your partner is HIV-positive (known as serodiscordant or mixed-status couples)
• You are not in a monogamous relationship (you or your partner also have sex with other people) and you do not always use condoms
• You inject illegal drugs or share needles
• You have a partner who is HIV-positive, and you want to get pregnant. PrEP may help protect you and your baby.

The Centers for Disease Control and Prevention estimates that PrEP could prevent transmission in as many as 140,000 serodiscordant heterosexual couples. Learn more about PrEP.

Post-exposure prophylaxis (PEP)

PEP is an anti-HIV medicine for people who may have been very recently exposed to HIV. If you think you have been exposed (for example, if a condom breaks), or if you were sexually assaulted, talk to your doctor or nurse about taking PEP.

You must take PEP within three days of exposure to help lower your risk for HIV. You then take two to three antiretroviral medicines for 28 days to prevent the virus from copying itself and spreading through your body.

While taking PEP, you still need to take steps to prevent HIV, including using a condom with sex partners. 

Antiretroviral medicines

If you are HIV-positive, taking antiretroviral (ARV) medicine can reduce your viral load (the amount of HIV in your blood) to keep you healthy. Knowing your viral load measurement and how to control it by reducing it to undetectable levels can protect your unborn baby during pregnancy, labor, and delivery. It can also help prevent spreading HIV to your sexual partner.

What are some behaviors that can raise a woman’s risk for HIV?

Behaviors that raise a woman’s risk for HIV include:

• Having sex with a male partner who has had sex with another man or who has used intravenous (IV) drugs. Sex with a man is the most common way women are infected with HIV.
• Using injection drugs and sharing needles. This is the second most common way that HIV is spread.
• Abusing drugs and alcohol. This can lead to risky behavior, including having sex without a condom, not knowing a partner’s HIV status, or injecting drugs.

Women who drink alcohol or use drugs may also be at higher risk of sexual assault or rape, which may put you at risk for HIV. If you are assaulted or raped, you need to see a doctor right away. Your doctor may decide that you should get post-exposure prophylaxis (PEP). These drugs may lower your chances of getting HIV after you have been exposed to the virus. But these drugs work only if you see a doctor within three days of exposure.

How can I prevent HIV if I inject drugs?

Intravenous (IV) drug users who share needles are at high risk for HIV. Sharing needles can place another person’s blood right into your body, even if the amount is so small that you can’t see it on the needle.

People who inject steroids, insulin, or medicines for other health problems are at risk for HIV if they do not use sterilized needles every time. Whenever you need to use a needle, be sure that it is sterilized. Do not share needles with anyone. You can also get HIV if the equipment used for body piercings and tattoos is not sterilized.

If you inject drugs or medicines, follow these steps to lower your risk of getting HIV:

• Never reuse or “share” needles, syringes, water, or drug preparation equipment.
• Only use needles and syringes that you got from a reliable source (such as drugstores or needle exchange programs).
• Use a new, sterile needle or syringe each time.
• If you must use a needle used by others, clean it with bleach before using it.
• If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).
• Use a new or disinfected container (“cooker”) and a new filter (“cotton”) to prepare drugs.
• Clean the injection site with a new alcohol swab prior to injection.
• Throw away needles and syringes after one use. Do not throw them in the regular trash. You can use an old laundry detergent or milk jug to collect used needles and syringes and then seal the container before disposing of it. Check with your local health department about the correct way to throw away the container.
• Don’t share needles or syringes with friends or family.

How can I prevent HIV if I get tattoos or body piercings?

Follow these steps to lower your risk of getting HIV:

• Ask questions about how the staff sterilizes their equipment. Single-use instruments that cut the skin should be used once and then thrown away. Reusable instruments that cut the skin should be cleaned and sterilized between uses.
• Find out what steps the staff takes to prevent HIV and other infections, like hepatitis B and hepatitis C.
• Make sure your tattoo parlor follows state regulations and health inspections.

I’m pregnant and have HIV. Will my baby get HIV?

If you are getting treatment for HIV, the answer is most likely no. When HIV medicine is used consistently and correctly, a pregnant woman living with HIV who is treated for HIV early in her pregnancy can lower the risk of delivering a baby with HIV to less than 1%. Without treatment, this risk is about 25% in the United States.

All women need to be tested for HIV during their first prenatal care visit, early in the pregnancy. High-risk women who get a negative HIV test result should be tested again later in pregnancy.

Treatment, called antiretroviral therapy, works best when it is:

• Started as early as possible in pregnancy
• Also given during labor and delivery
• Given to the infant after birth

If you are HIV-positive and your viral load is greater than 1,000 copies per milliliter, your doctor may recommend delivering your baby by cesarean (C-section).

I have HIV. Can I breastfeed my baby?

No. If you have HIV, do not breastfeed. In the United states and other countries where clean water is available, using a breastmilk substitute like formula is strongly recommended for women with HIV, because you can pass the virus to your baby through breastmilk.

You can also ask your doctor, midwife, or pediatrician about getting human breastmilk from a milk bank. Find a human milk bank through the Human Milk Banking Association of North America.

Recommendations about breastfeeding with HIV may be different for other countries where clean water is not always available.

How can I help protect my children from HIV?

One way to help protect your children from HIV is to talk to them about HIV, AIDS, and the sexual behaviors that raise their risk for HIV and other sexually transmitted infections (STIs). The earlier you start talking about it, the better. By the third grade, almost all children have heard about HIV.

According to a 2013 national survey of high school students:

• About half of all students have had sex at least once
• One-third are sexually active (have had sex in the past three months)
• Nearly half of the students who are sexually active did not use a condom the last time they had sex

Offsite Resources

For more information about HIV prevention check out the following resources from other organizations:

• Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents — Clinical guidelines from AIDS on antiretroviral therapy (ART).
• HIV Risk and Prevention — Information from the CDC.
• The Basics of HIV Prevention — Fact sheet from AIDS.
• Preexposure Prophylaxis for the Prevention of HIV Infection in the United States — 2014 — Clinical practice guidelines from the Centers for Disease Control and Prevention and the U.S. Public Health Service.

The post HIV Prevention for Women appeared first on Medika Life.

When taken daily, PrEP is highly effective for preventing HIV. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily. Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily. PrEP is much less effective if it is not taken consistently.

As PrEP only protects against HIV, condoms are important for the protection against other STDs.

How does PrEP work?

What is the difference between PrEP and PEP?

• Post = after
• Exposure = coming into contact with HIV
• Prophylaxis = treatment to prevent an infection from happening

Post-exposure prophylaxis (PEP) is an HIV prevention strategy where HIV-negative individuals take HIV medications after coming into contact with HIV to reduce their risk of becoming infected. PEP is a month-long course of drugs and must be started within 72 hours after possible exposure.

Who does PrEP work for

PrEP has been shown to help reduce HIV infection risk in multiple studies. The iPrEx trial showed that PrEP reduces the risk of HIV infection among gay and bisexual men and transgender women. Two large trials, Partners PrEP and TDF2, showed that PrEP also reduces the risk of HIV infection among heterosexual men and women. The Bangkok Tenofovir Study demonstrated that PrEP works for people who inject drugs.

Effectiveness

Truvada for PrEP provides 92%-99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed. If a daily dose is missed, the level of HIV protection may decrease. It only works if you take it. People who use PrEP correctly and consistently have higher levels of protection against HIV.
According to data analysis from the iPrEx study that found PrEP to be effective:

• For people who take 7 PrEP pills per week, their estimated level of protection is 99%.
• For people who take 4 PrEP pills per week, their estimated level of protection is 96%.
• For people who take 2 PrEP pills per week, their estimated level of protection is 76%.

There are not enough data available to provide specific timing guidance on non-daily use, so the FDA recommends PrEP be used daily to achieve the highest level of protection.
A few things to note:

• When starting PrEP, it takes at least seven days to reach high levels of protection against HIV.
• When stopping PrEP, individuals should continue using PrEP for four weeks after the last significant exposure.
• PrEP does not protect against other sexually transmitted infections (STI) or pregnancy. It is not a cure for HIV.

Medication options for PrEP

Two medications, sold under the brand names Truvada® and Descovy® are approved for daily use as PrEP to help prevent a person without HIV from getting the virus from sex or injection drug use. You need to discuss your individual needs with your doctor and consider the possible side effects of each drug.

Truvada and Descovy belong to a drug class known as NRTIs, which inhibit and block the virus enzyme called reverse transcriptase. By blocking the action of reverse transcriptase, both drugs in combination with another ARV work together to prevent HIV from multiplying in the body. Both drugs are highly effective in reducing the amount of HIV in the T-cells (white blood cells).

Truvada® 

Truvada is an NRTIs drug designed to intercept and inhibit or block the HIV virus enzyme called reverse transcriptase. This enzyme actively infects the DNA and uses it to make copies of the virus. Once these cells are infected, the body’s immune function becomes weaker as the viral load count increases.

Truvada, combined with another ARV medicine, work together to prevent the virus from increasing or replicating in the CD4 cells. The more a patient uses Truvada, the more its concentration in the body increases and becomes highly effective in reducing the amount of HIV in the T-cells (white blood cells).

As PrEP, Truvada intercepts the virus before it enters into the body. PrEP is an effective strategy where the active substances in Truvada stay alert to kill the virus in its early stages before it inhibits the cell DNA causing AIDS.

• You must be HIV-negative before you start and while taking TRUVADA for PrEP. Do not take TRUVADA to reduce the risk of getting HIV-1 unless you are confirmed to be HIV-negative.
  • Get tested for HIV-1 immediately before and at least every 3 months while taking TRUVADA.
  • If you think you were exposed to HIV-1, tell your healthcare provider right away.
• Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have flu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a flu-like illness within the last month before starting or at any time while taking TRUVADA.
  • Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin.
• You must continue to use safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1.
  • Do not miss any doses of TRUVADA. Missing doses may increase your risk of getting HIV-1 infection.

Serious side effects of TRUVADA may also include:

• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA.
• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.
• Bone problems, including bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Common side effects in people taking TRUVADA for PrEP are headache, stomach-area (abdomen) pain, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

Descovy®

Descovy® for PrEP is recommended to prevent HIV for people at risk through sex, excluding people at risk through receptive vaginal sex. Because Descovy has not yet been studied for HIV prevention for receptive vaginal sex, it may not be appropriate for some people.

Descovy works the same way as Truvada. It is a nucleoside reverse transcriptase inhibitor which actively undergoes intracellular metabolism where tenofovir alafenamide is first hydrolyzed to tenofovir-alanine, and converted into parent tenofovir.

The action of tenofovir (tenofovir diphosphate) as it enters the body is to inhibit the activity of virus reverse transcriptase, causing viral DNA chain termination. Once the virus’ active action is terminated, there is no more replication of the virus and the CD4 cell count begins to increase in number, restoring the body’s immune function.

Note that Descovy doesn’t cure HIV. It reduces its viral count in the T-cells and the more you consistently use this medication, the more the viral load count decreases.

Before and while taking DESCOVY for PrEP:

• You must be HIV-negative before you start and while taking DESCOVY for PrEP. You must get tested for HIV-1 immediately before and at least every 3 months while taking DESCOVY. If you think you were exposed to HIV-1, tell your healthcare provider right away. They may want to do more tests to confirm that you are still HIV-negative.
• Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. Tell your healthcare provider if you had a flu-like illness within the last month before starting or while taking DESCOVY. Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin.
• DESCOVY by itself is not a complete treatment for HIV-1. Do not take DESCOVY for PrEP unless you are confirmed to be HIV-1 negative.
• DESCOVY does not prevent other sexually transmitted infections (STIs). Practice safer sex by using a latex or polyurethane condom to reduce the risk of getting STIs.
• To further help reduce your risk of getting HIV-1:
  • Do not miss any doses of DESCOVY. Missing doses may increase your risk of getting HIV-1.
  • Know your HIV status and the HIV status of your partners. If your partner is living with HIV, your risk of getting HIV is lower if your partner consistently takes HIV treatment every day.
  • Get tested for other STIs. Some STIs make it easier for HIV-1 to infect you.
  • Talk to your healthcare provider about all the ways to help reduce HIV risk.

DESCOVY can cause serious side effects:

• Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to check your health or give you HBV medicine.

Who should not take DESCOVY for PrEP?

Do not take DESCOVY for PrEP if you:

• Already have HIV-1 or if you do not know your HIV-1 status. If you have HIV-1, you need to take other medicines with DESCOVY to treat HIV-1. If you have HIV-1 and take only DESCOVY, your HIV-1 may become harder to treat now and in the future.

What are the other possible side effects of DESCOVY for PrEP?

Serious side effects of DESCOVY may also include:

• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with DESCOVY. If you develop kidney problems, your healthcare provider may tell you to stop taking DESCOVY.
• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

Common side effects in people taking DESCOVY for PrEP are diarrhea, nausea, headache, fatigue, and stomach pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

Want to know more?

This website, dedicated to everything related to PrEP will answer any questions you may have relating to PrEP. PREPFACTS

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