Chapter 23 Download Chapter
Preventing HIV Acquisition
Family planning providers can help adolescents and women who are at risk for HIV stay negative. They can do this by sharing accurate information about HIV prevention measures, and by providing condoms, and access to pre- and post-exposure prophylaxis (PrEP and PEP) as needed.
Ways for women to prevent HIV acquisition:
- Use male or female condoms and lubricant correctly every time you have sex; this will prevent HIV and other STIs.
- Avoid unprotected sexual contact with partners who are living with HIV and those who do not know their HIV status; always use condoms and consider taking PrEP.
- Encourage partners to test for HIV.
- Know your partner’s status and encourage them to start HIV treatment if they are HIV-positive.
- Take PrEP as prescribed.
- Use sterile needles/syringes if injecting drugs.
- Women who have experienced sexual violence or abuse should be offered post-exposure prophylaxis (PEP) and emergency contraceptive pills (ECPs) in a supportive and non-judgmental environment (for details, see Chapter 3 – Emergency Contraceptive Pills).
Women who exchange unprotected sex for goods or money, have multiple sex partners, inject drugs, or have sex with men who inject drugs are at especially high risk for acquiring HIV. They should also be provided condoms and lubricants, and be offered PrEP or PEP, depending on the situation. It is important to remember that all family planning methods are safe (with the exception of spermicides) and effective for these women and should be initiated as soon as possible, if desired.
PrEP, or pre-exposure prophylaxis*, is a pill that is taken every day by a person who is HIV-negative to prevent that person from being infected with HIV if or when they are exposed to the virus. PrEP is a combination of HIV medicines, but it is not treatment for HIV. PrEP is safe and can be offered to adolescents and women living in high HIV burden areas or at high risk for HIV for other reasons. PrEP can safely be used with all types of contraceptive methods, including hormonal methods, and is safe to use when breastfeeding. Additional information about PrEP can be found in Chapter 22 – Sexually Transmitted Infections, Including HIV, section on Avoiding Sexually Transmitted Infections.
PEP, or post-exposure prophylaxis, is an emergency method of preventing HIV infection. A person who is HIV-negative would need to take a 4-week course of antiretroviral drugs (ARVs) starting very soon after—and never later than 72 hours after—that person may have been exposed to HIV. It is an emergency measure, rather than a regular method of preventing HIV transmission. It is a valuable preventative treatment for those seeking family planning services after experiencing sexual violence, forced or coerced sex, or after having unprotected sex (or condom failure) with someone living with HIV who is not virally suppressed through use of antiretroviral therapy (ART), or with someone whose HIV status is unknown. Like PrEP, PEP can safely be taken with all types of contraceptive methods, including hormonal methods, and is safe to use when breastfeeding.
* Currently there are several new long-acting HIV prevention options (including the dapivirine vaginal ring and the cabotegravir long-acting injectable) and combination HIV prevention and contraceptive products which have either recently been shown to be effective or are under development. In the future, providing these options in contraception services could be acceptable for women, and feasible. A program of operational research is planned to understand how these new options could be provided safely to enable the greatest impact.