In order to make the prevention of HIV a priority in women’s lives, HIV prevention education needs to take into account women’s life circumstances.

Currently, the main methods of protection against HIV transmission are:

  • the use of condoms and other physical barriers
  • using new needles when injecting drugs
  • the treatment of HIV-positive people to reduce viral load
  • pre-exposure prophylaxis and post exposure prophylaxis (PrEP and PEP)

Power imbalances in women’s lives, whether economic, physical, or social, impact their ability to prevent HIV transmission. Women need accessible and affordable self-controlled methods of prevention that do not require the knowledge or consent of their sexual and/or injection partners. As research advances and new prevention technologies are made more accessible, prevention for women is showing future promise.

How do they work?

Condoms are physical barriers that can reduce the risk of a sexual exposure to HIV and sexually transmitted infections (STIs). They are made of materials that do not allow HIV or STIs to pass through them. Condoms can be highly effective against HIV and STI transmission when used consistently and correctly.

What are the options?

Women looking to use condoms to protect against HIV transmission have two types of condoms available to them:

  • the external (also called male) condom
  • the insertive condom (sometimes referred to as the 'female condom')

Condoms are typically made of latex but polyurethane options are also available. Insertive condoms are always made from polyurethane, can be inserted into the vagina or anus up to 8 hours in advance, and may be a good option for people whose partners will not or cannot use external and/or latex condoms. However, insertive condoms are more expensive and less available than external condoms.

Dental dams are a square piece of latex that can be used as barrier for vaginal*, or anal oral sex. Flavoured condoms or non-lubricated condoms can be used for oral sex on a penis.**

For more information on preventing HIV and STI transmission through condom use.

 

* Trans men and transmasculine folks who have not had genital surgeries may refer to their genitals using all kinds of language. Some people may use the term ‘front hole’ to refer to these parts. For more information about language, and safer sex with trans men, see: http://www.catie.ca/en/resources/primed-sex-guide-trans-men-men

 

** Trans women and transfeminine folks who have not had genital surgeries may refer to their genitals using all kinds of language. Some people may choose to use the term ‘strapless’ to refer to these parts. For more information about language, and safer sex with trans women

The transmission of HIV is far more likely when the amount of HIV in a person’s bodily fluids (viral load) is high. Research has shown that the consistent and correct use of HIV medications by people living with HIV can lower a person’s viral load to undetectable levels. When a person living with HIV is maintaining an undetectable viral load, the risk of transmitting HIV to their partner(s) falls dramatically, by as much as 96%. 

The risk of passing on HIV can vary during the menstrual cycle due to changes in the levels of HIV in vaginal fluid. HIV levels are likely to be highest around the time of a period, when cells containing HIV are most likely to be found in vaginal fluid, along with blood.

Viral load testing is part of routine checkups for people living with HIV who are engaged in care and on treatment. Accessing and staying engaged in care has shown improved health outcomes for people living with HIV, and is a very effective prevention tool.

To learn more about supressing viral load as a prevention method

What is PrEP?

Pre-Exposure Prophylaxis (PrEP) refers to a way for HIV-negative people to reduce their risk of becoming HIV positive by taking medication that has been traditionally used to treat HIV. Currently, only one type of PrEP (daily oral Truvada pills) has been approved by Health Canada to prevent HIV transmission through sexual contact.

Does it work?

Across numerous studies and reports, PrEP has proven to be over 90% effective at preventing the transmission of HIV when taken as directed. (use as pull quote) In studies where PrEP was tested for efficacy in cis women, the initial results indicated that it was not as effective in achieving protection in vaginal and cervical tissue, however, the women in the trials were shown to have not taken PrEP as prescribed. PrEP needs to be taken for a minimum of 20 days to protect against HIV transmission in vaginal tissue and 7 days in rectal tissue. This means it takes longer to be effective for vaginal sex than anal sex.

While there is not enough research about PrEP’s effectiveness among trans women to draw firm conclusions, the research that does exist suggests that PrEP is highly effective at preventing HIV acquisition among trans women, when taken as directed. No research, however, has looked at how PrEP works for trans women who have had genital surgeries.

Why should women care about PrEP?

There are numerous potential advantages of PrEP. For example, PrEP may provide another method of protection for:

  • women who are unable to negotiate condom use with their partner(s);
  • women in mixed status relationships (where one person is HIV-negative and the other is HIV-positive);
  • women who wish to conceive a child through sex with an HIV-positive partner;
  • women who inject drugs but are not able to obtain new needles;
  • women who sex work or;
  • women who have difficulty using condoms consistently for any reason.

Is PrEP accessible?

Currently, Truvada as PrEP is not available through Ontario’s public health coverage (Trillium) which means that without private insurance, women interested in accessing Truvada as PrEP will have to pay approximately $1,000 per month.

To learn more about PrEP, including information about microbicides and other new forms of PrEP in development

To learn more about PrEP during pregnancy and/or while breastfeeding

What is PEP?

PEP, or post-exposure prophylaxis is a way for a person who may have recently been exposed to HIV to prevent HIV infection. It involves taking HIV medications right after a potential high-risk exposure to HIV. PEP must be accessed as soon as possible and no more than 72 hours after exposure to be effective and consists of a 28 day course of HIV medication. It is not 100% effective.

Is PEP accessible?

PEP can be accessed through emergency rooms and the cost will be covered by OHIP for exposure through sexual assault or exposure in the workplace (for example a health care worker who accidentally experiences a needle-stick injury). For other high-risk exposures, the cost of PEP is charged to the person accessing it and will cost around $1,000 for the 28 day treatment. If you have private insurance, PEP will be covered. If you do not have private insurance and cannot afford the medications, you can work with emergency room staff and ask if they can be provided to you free of charge. 

It is important to note that across Ontario, access to PEP in emergency rooms is inconsistent. PEP may not be readily available and the decision to prescribe PEP will be left to the discretion of the healthcare provider.

For more information on PEP

When a person living with HIV is maintaining an undetectable viral load, the risk of transmitting HIV to their partner(s) falls dramatically, by as much as 96%. 

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