Women living with HIV in the UK are often diagnosed during antenatal care. Yet birthworkers are not always trained in, or aware of the most current HIV prevention strategies. It is useful to learn more about these strategies and their benefits for women. As birthworkers of colour, it’s worth remembering those most in need of support and advocacy around HIV are women from our ethnic minority communities.

HIV prevention strategies are essential for achieving reproductive justice. Reproductive justice is a term more commonly used in the United States, but is gaining traction in Britain as a useful framework for understanding the health concerns of women of colour. SisterLove, Inc., a women-centred HIV and sexual and reproductive justice advocacy organization, defines reproductive justice as:

“an intersectional analytical framework that allows us to interrogate interlocking systems of power, and to address the root causes and the distributive impact of oppressive sexual and reproductive health policy, law, and culture on the lives of people living with HIV”. (1)

Reproductive justice can also be a useful framework when advocating for people at high risk of acquiring HIV. Basing our advocacy and activism on these interlocking systems of power is necessary for stopping HIV transmission.

As birthworkers, you’re speaking to people who certainly have been, and most often, will again be sexually active. Although some key groups are more at risk, anyone who is sexually active can be at risk of STIs and HIV. For this reason, it is important that birthworkers feel comfortable talking to women about pre-exposure prophylaxis (PrEP) in conversations about preventative sexual health behaviours and well being. Oral PrEP* is known to be effective (2) at preventing HIV, and has been the driving force behind massive local reductions in HIV diagnoses (3). It is safe to take while trying to conceive and when pregnant or breastfeeding (4).

Before considering starting PrEP it’s important for the person to be sure they do not already have HIV, and to have a normal kidney function. Regular HIV and STI testing are recommended, as they are for all sexually active people. PrEP is the newest method of HIV prevention, its patented version carries an unjustifiably-high cost and NHS England has engaged in legal battles that has limited its availability. Thus, it will take some time before it is viewed as an integral part of our sexual health prevention toolkit. Women who want PrEP may face additional barriers trying to access it, relating to availability and perceived eligibility. The biggest barrier is that it is currently only available from sexual health clinics, but lots of women of colour do not access (sexual) health care through such services.

However, women are often in situations where PrEP would be a useful option. These situations include: having high-risk sexual encounters or frequent partner change, having sexual partners who are living with HIV and not yet on an effective medication regimen, or having a partner who they suspect of covertly having other sexual partners. PrEP use in these situations may be time-specific, and combined with other prevention strategies for other STIs and pregnancy.

For individuals, PrEP provides a unique opportunity for women to be empowered and in control of their own HIV prevention, as part of planning around their pleasure-seeking and sexual encounters. For public health, women’s access to PrEP is a key component in HIV reduction. For reproductive justice, improving access to PrEP helps address the profound sexual health inequalities affecting women of colour and underserved communities.

For people fielding questions about vaginas, fertility and sexual activity, there may be regular opportunities to talk to women about sexual health, prevention and wellbeing, and opportunities for sexual health promotion. Therefore, it’s worth considering prevention messages, and birthworkers being part of a cultural shift where PrEP is heralded as a game-changer for women and an integral HIV prevention option.

Josina Calliste is a sexual health researcher and Strategic Lead for Women at Prepster

If you would like more information or resources on PrEP:
https://prepster.info/prep4women/
Instagram + Twitter – @teamprepster:
Facebook – prepster.info
Put the power in your hands – Dr Nneka Nwokolo’s TEDtalk: https://www.youtube.com/watch?v=q_WsJFa3nog
PrEP 17 – The coming of age of PrEP documentary