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What to Know About PrEP for Women

Medically Reviewed by Carmelita Swiner, MD on April 21, 2022

Scientists are still working on a cure for HIV, or human immunodeficiency virus. Antiretroviral therapy (ART) can help you live longer if you get sick. But it’s best to stop an infection in its tracks. Pre-exposure prophylaxis, or PrEP, can help with that.

PrEP works well regardless of your gender identity or sexual orientation. Yet, only about 10% of women in the U.S. who could benefit from it get a prescription from their doctor.

Mental health issues like depression and intimate partner violence can make it harder for some women to guard against HIV. So can other barriers like racism, discrimination, and HIV stigma. Lack of knowledge about PrEP can also stand in your way.

Take control of your HIV protection by talking to your doctor about your risk. They’ll let you know if PrEP is right for you.

What Is PrEP?

It’s a daily medication for people who are more likely to get HIV from sex or drug use that involves needles.

There are different kinds of PrEP medications. But there’s only one approved for people who have receptive vaginal sex, which includes women, transgender men, and some nonbinary people. It’s emtricitabine/tenofovir (Truvada).

Emtricitabine/tenofovir is a pill you take every day. The virus-fighting drugs help stop HIV from setting up an infection and spreading in your body.

How Can PrEP Help Women?

One in four HIV-positive people in the U.S. are female.

Women most commonly get HIV when they have unprotected sex with a male partner. While it’s rare, it’s possible to get infected if your intimate partner is an HIV-positive female. The virus can spread through cuts, bleeding gums, sores in your mouth, or menstrual blood or shared sex toys.

The good news is that overall HIV rates are going down in the U.S. But there are still racial and ethnic disparities among people who get infected. Most women diagnosed with HIV are Black, and Hispanic women are also disproportionately affected. This imbalance shows up in transgender women, too.

Women of color, especially those who speak Spanish, are also less likely to use or know about PrEP.

A trusted health professional can help you decide if PrEP is right for you. It’s often recommended for people who’ve had anal or vaginal sex in the past 6 months and have:

  • A sexual partner with HIV
  • Been diagnosed with a sexually transmitted infection (STI) in the past 6 months
  • A sexual partner who has risky sex with other people
  • A partner who uses injectable drugs
  • Used post-exposure prophylaxis (PEP) more than once

It’s also recommended if you don’t always use a condom. You might also benefit from PrEP if you use injectable drugs and you:

  • Have an injection partner with HIV
  • Share needles, syringes, or other tools for drug use

PrEP may protect you and your baby from getting HIV. It’s safe to take if you’re trying to get pregnant, during pregnancy, and while you’re breastfeeding.

You can take PrEP with hormone therapy. There’s no evidence that these drugs interact with each other. But it’s a good idea to talk with your doctor if you’re worried about how PrEP might affect any of your medications.

How Do You Get Started?

You’ll need an HIV-negative test and a prescription from a health provider. Make an appointment with your regular doctor if you have one. Or search for HIV clinics or PrEP providers in your area through websites such as:

  • HIV/AIDS Prevention & Service Provider Locator (locator.hiv.gov)
  • Prep Locator (preplocator.org)

After you get started with PrEP, you’ll need to see your doctor regularly. You may need to go every 3 months for:

How Do You Pay for PrEP?

Most insurance providers cover PrEP, including private plans or government programs like Medicaid. But you can get help paying for your medicine even if you don’t have health coverage.

You can get PrEP services for free or at a lower cost through:

  • Ready, Set, PrEP (readysetprep.hiv.gov)
  • Copay assistance programs though drug companies
  • State PrEP assistance programs

Visit the CDC website’s “Paying For Prep” section for more guidance. You’ll also find info about assistant programs through the website of the National Alliance of State and Territorial AIDS, or NASTAD.org. Your doctor, nurse educator, or social worker are other good sources.

How Effective Is PrEP?

When you take it exactly as prescribed -- meaning every day -- PrEP can lower your chances of getting HIV from sex by about 99%. Your odds of getting it from injection drug use go down by at least 74%.

PrEP won’t work as well if you skip doses. But there’s some evidence that you can protect against HIV if you take it at least 6 days a week.

You might hear that PrEP can ward off HIV infection if you take it at least 4 days a week. But that’s based on studies on men who have sex with men. It might not work the same way for women. It’s not clear if levels of the drug stay in vaginal tissue as well as a man’s anal tissue.

PrEP also needs time to build up in your body. For receptive vaginal sex, it can take up to 21 days from your first pill until it’s most effective.

PrEP protects you most when you take it every day, preferably at the same time. Download a free app, schedule an alert on your smartphone, or put a sticky note somewhere to remind you. It might help to take your pills during another daily routine, like brushing your teeth.

Let your doctor know if there’s anything they can do to make it easier for you to take PrEP.

PrEP works really well to prevent HIV, but it’s not 100% effective. You can lower your chances of HIV even more if you take other safe-sex measures such as always using a condom.

What Are the Side Effects of PrEP for Women?

PrEP is safe. But like all medication, it can cause some unwanted side effects. They’re usually mild and go away in about a month. Tell your doctor if your symptoms stick around or get worse.

Common side effects include:

  • Belly pain or a sick feeling
  • Headache or tiredness
  • Throwing up
  • Less desire to eat
  • Diarrhea

Get medical help right away if you have a fever and chills along with:

Can You Stop PrEP?

Talk to your doctor before you make any changes to your medication. They’ll help you find other ways to prevent HIV that might be easier for you.

Some reasons you might choose to stop taking PrEP include:

  • Your chances of HIV go down because of life changes
  • You can’t remember to take a pill every day
  • PrEP side effects are too hard to handle
  • Your body reacts to PrEP in an unsafe way

Who Shouldn’t Take PrEP?

Tell your doctor if you have kidney or liver disease or you’re allergic to any medication. They’ll consider that when deciding if PrEP is right for you.

PrEP isn’t a good choice if you’ve had recent exposure to HIV. Talk to your doctor or another health provider if you’ve had contact with HIV within the past 72 hours. Post-exposure prophylaxis (PEP) might be right for you. Go to the emergency room or visit an urgent care center if you need help right away.

Show Sources

SOURCES:

CDC: “HIV: PrEP Coverage,” “HIV: Prevention Challenges,” “PrEP is for Women,” “Truvada Medication Information Sheet,” “HIV: HIV Prevalence,” “MMWR: Racial, Ethnic, and Gender Disparities in Awareness of Preexposure Prophylaxis Among HIV-Negative Heterosexually Active Adults at Increased Risk for HIV Infection – 23 Urban Areas, United States, 2019,” “HIV: Special Focus Profiles,” “HIV: Paying For PrEP,” “PrEP Effectiveness.”

Office on Women’s Health: “Women and HIV.”

HIVinfo.NIH.gov: “HIV and Specific Populations.”

HIV.gov: “Impact on Racial and Ethnic Minorities.”

AIDS Care: “Racial and ethnic differences in women’s HIV risk and attitudes towards pre-exposure prophylaxis (PrEP) in the context of the substance use, violence, and depression syndemic.”

Topics in Antiviral Medicine: “Maximizing the Benefits of HIV Preexposure Prophylaxis.”

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