US Women & PrEP: Remember Us?

The New York Times recently ran an article about the use of Pre-Exposure Prophylaxis (PrEP) as the next great sexual revolution – it compared the impact that the pill made for women to the impact that PrEP can make for men who have sex with men (MSM).

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Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/statistics/surveillance/incidence/

We certainly cannot ignore the high rates of new infections among MSM.  According to the Centers for Disease Control and Prevention (CDC), in 2010 63% of new infections are among men who have sex with men. But that statistic, as alarming as it may be, does not mean that we should ignore other vulnerable populations.

On May 14, 2014, the CDC came out with new guidelines for providers on assessing risk and prescribing PrEP. And those guidelines focused on all vulnerable populations – including women.  Though it’s important that we see PrEP for what it is – and the positive outcomes that it will support – as an important step forward in HIV prevention and treatment, that step is not exclusive to men.

Let’s remember that the HIV epidemic is diverse and focus on the ways that our prevention and treatment efforts can reach all vulnerable populations.  We need to decrease stigma associated with PrEP and ensure that providers increase access to PrEP for both men and women.  We need to ensure that there is an effective outreach strategy in place to reach both men and women who are at risk of HIV infection.

TWC calls on public and private entities involved in guideline development and dissemination to work with obstetricians, gynecologists, and thought leaders in women’s health to ensure increasing voluntary and informed discussion of PrEP by providers and use of PrEP by vulnerable populations. We also strongly recommend collaboration between guideline-making bodies and community-based women’s organizations, both within and beyond the HIV arena, the U.S. Women and PrEP Working Group, AVAC, and a diverse group of HIV stakeholders to ensure that guidelines are practical and inclusive of all populations, including women and people of color.

What are your thoughts on PrEP outreach and roll-out? How can we further ensure that women have access to PrEP?

The State of Sex Education in the US: Room for Improvement

In April, the Huffington Post using data from the Guttmacher Institute produced some pretty scary infographics highlighting the state of sex education (or lack thereof) in this country.  While it’s shocking that many states have no sex education requirement, it’s doubly shocking that where sex education is provided, that there are MANY states in which there is no requirement that: 1) HIV information be included or that 2) Information provided be medically accurate.

SexEdMaps1_2Of course, sexuality education courses aren’t the only place that people are getting their information—they’re getting it from movies, television, friends, parents, and, increasingly, people, and youths in particular, are getting their information from the Internet.  The thing about all of those sources, though, is they’re often not medically accurate.  Television and movies rarely show people practicing safe sex—you don’t see a conversation between two people about whether or not they’ve been tested, how recently, if they have a condom—and then you also rarely see consequences from that failure to negotiate safe sex or condom use (unless it contributes to some juicy story line or plot twist).

On the other hand, in a 2009 study, half of the websites that occurred within the top 10-15 hits on Google when someone searched for terms like “birth control,” “morning after pill,” or “sexually transmitted disease” failed to provide accurate or complete information.  Further, an issue brief released by the National Alliance of State and Territorial AIDS Directors (NASTAD) that supported the qualitative data from our previous youth intervention findings showed that the misconceptions held by adults around HIV and sexual health can be passed through generations leading to increased silence around risk and reduced knowledge of the need for prevention services and care.

SexEdMaps4So with all of that misinformation out there, it’s even more imperative to ensure that schools have comprehensive and accurate sex education.  And comprehensive means comprehensive – not just one hour in health class in spring of your Sophomore year. It means starting to provide age-appropriate sexual health information at a young age that enables young people access to medically accurate information rather than misinformation and myths.

And it’s not just about the right to have accurate information—this cloud of misinformation around sexual health has real consequences. In 2010, youth between ages 13 and 24 made up 17% of the population, but made up 26% of new HIV infections. Most importantly, education on sexual health does not lead to an increase in sexual activity. Quality sexual health education often delays sexual activity, increases condom use, and decreases the total number of sexual partners. This data just goes to show that failing to provide sex education, failing to talk about HIV or STIs or contraceptives or condoms, failing to require information to be medically accurate—we’re not stopping young people from being sexually active! They will continue to engage in sexual activity, but the difference is that they won’t be safe or smart about it.

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Just as our health care providers have a responsibility to provide accurate information, our schools and our health classes have a responsibility to provide accurate sexual health information. Young people—and people of all ages—have a right to accurate and complete information about their sexual health so they have the tools to make the decisions that are right for them.

Ryan White Part D Funding: What about Women and Families?

Family 1 SlideOn March 4, 2014 President Obama released his proposed budget for FY 2015. While his budget doesn’t go into effect without congressional approval, and it’s unlikely that congress will approve it without making any changes—the President made an important change in the way HIV related services are funded. The proposed budget condenses Part D of the Ryan White Program (which focuses on providing supportive services and medical services to women and families) into Part C (which provides comprehensive services without a focus on any specific group impacted by HIV/AIDS).

This proposal isn’t itself particularly concerning—Part D funds have always been very competitive and difficult to compete for so the compression of Part D into Part C may open up some new funding opportunities for community-based organizations (CBOs) that had been previously shut out of Part D funding. It also makes sense from the standpoint that there are less children being born with HIV and therefore a reduced need for funding those targeted services.

But we can’t forget about women and families.

The real concern with this proposal is the small part it plays in a larger movement in HIV/AIDS advocacy and funding that increasingly forgets about women and families and their unique needs and barriers. Language matters. Even though there are no funds being diverted out of the Ryan White program, removing “women and families” sends a problematic message about the focus of HIV/AIDS advocacy and services, who is living with HIV, and what their needs are. It lumps everyone living with HIV/AIDS into the same boat when they have distinctly different and complex needs—for women and families, those needs are often ignored.

There’s an argument that women and families served by Part D of the Ryan White program can get those same services through providers that receive Part C funding. That’s technically true. But those providers often don’t have woman-focused or youth-focused services that we know are effective. Women and youth may have a more difficult time articulating their needs and getting those needs met. As a woman-focused CBO, we have a first-hand view of what those needs are. Women aren’t just looking for access to quality health care or treatment. They’re looking for food so they can feed their families; housing so they can provide their families with stability and safety; employment so they can feel empowered to take care of themselves and their families; childcare so they can get to doctor’s appointments and to work; education so they can better themselves and set a good example for their families…

The needs of women go well beyond just taking medicine and adhering to treatment. As we lose focus on women and their needs, we are making it more difficult for them and families to enter and stay in care. The Women’s Collective urges the President and Congress to ensure that in the fight against HIV/AIDS, women are not left behind.