HIV Prevention

HIV prevention is key in reducing new HIV diagnoses. In order for prevention to work, strategies must take into account women’s life circumstances.

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How to prevent HIV

There are currently five main methods of protection against HIV transmission outlined here.

Power imbalances in women’s lives impact their capacity 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 improving.

HIV Prevention Methods: Quick Links

Condoms and other physical barriers when engaging in sexual activity
Harm Reduction and Safer Drug Practices
HIV treatment to reduce the viral load of people living with HIV
PrEP, PEP & PIP

Condoms & Physical Barriers

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 are highly effective against HIV and STI transmission when used consistently and correctly.

Condoms for the prevention of HIV transmission

External Condoms

Internal Condoms

Dental Dams

Flavoured or Non-Lubricated Condoms

Harm Reduction and Safer Drug Practices

Safer drug use practices have been proven to reduce HIV transmission.

WHAI’s Harm Reduction Toolkit

Red cover with orange poppies titled "Women and Harm Reduction In Ontario: A Capacity Building Toolkit" (2020).

How does harm reduction impact HIV transmission?

“Distributing harm reduction equipment for safer injecting, smoking and snorting has been proven to be an effective way to prevent or reduce many potential harms, including the risk of HIV and hepatitis C transmission. Programs that distribute harm reduction equipment can often be an important point of contact with the healthcare system for people who use drugs, and they can help people to access other community supports services. Combining harm reduction equipment distribution with other programs can increase their effectiveness.”

Reducing harms for people who use drugs: Emerging approaches and time-honoured programs

Are there harm reduction practices or program locations across Ontario?

Where can I read more about WHAI’s Harm Reduction work?

HIV treatment to reduce the viral load of people living with HIV

Undetectable = Untransmittable*

Living in the Asterisk(*): What does U=U mean for women?

Poster titled "Living in the Asterisk (*)" with asterisk pattern, one in yellow.

Undetectable = Untransmittable

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 maintains an undetectable viral load for at least 6 months, they cannot transmit the virus sexually to other people. In 2020, almost 85% of people living with diagnosed HIV in Ontario were virally suppressed.

HIV in Ontario by public health unit: tests & diagnoses 2021, and care cascade 2020

Undetectable = Untransmittable is changing the lives of many people living with HIV; however, there are important considerations that are relevant for women.

Learn more about U=U and Women.

Viral Load Testing

PrEP vs. PEP vs. PIP

PrEP (Pre-Exposure Prophylaxis) is a prescription HIV prevention medication taken daily BEFORE a potential exposure.

Pre-Exposure Prophylaxis (PrEP)

Pre-Exposure Prophylaxis (PrEP) is a prescription medication for HIV-negative people to reduce their risk of contracting HIV. PrEP is a combination of two drugs that fight against HIV known as “antiretrovirals” and is typically taken daily. PrEP is safe and has been approved by Health Canada.

PrEP & Women: What You Need to Know

Does PrEP Work?

PrEP and Trans Women

PrEP and People Who Use Drugs

PrEP, Pregnancy, Breast & Chestfeeding

Why is PrEP Important for Women?

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

Have an HIV+ partner
Do not always use condoms
Have multiple sex partners
Do not know the HIV status of all sex partners
Use drugs and sometimes share equipment*
Are trying to get pregnant with and HIV+ partner

*Note: Research has shown PrEP to be slightly less effective when used to prevent transmission related to sharing injection equipment. Talk to a health care professional for more information about your options.

How do I access PrEP?

The Ontario Drug Benefit (ODB) program provides coverage for PrEP. This means that if you are collecting ODSP, OW, are enrolled in the Trillium Drug Program, or are over 65 years old, PrEP is now covered. ODB will also cover drug costs for those under the age of 24 who do not have private insurance as part of the OHIP+ program. PrEP is covered for First Nations and recognized Inuit people (with status) through the Federal Non-Insured Health Benefits Program. Some private insurance plans (i.e. coverage through a workplace or that you purchase on your own) may cover some or all of the cost of PrEP.

PrEPStart and PrEPSaver provide financial advice and support to help getting started on PrEP and find access to coverage.

If you do not have coverage through any of these means, PrEP is very expensive. It can cost between $250 - $1000 per month. Community groups continue to advocate for accessible PrEP. If you have questions, or face barriers accessing PrEP, contact your local health care provider or AIDS service organization.

Where can I read more about PrEP?

Post-Exposure Prophylaxis (PEP)

PEP is a medication that is prescribed after a potential HIV exposure and prevents HIV acquisition. PEP must be taken very soon after exposure, and no more than 72 hours after exposure. The earlier it’s accessed the more effective it can be.

PEP & Women: What You Need to Know

When might I want to get PEP?

How do I access PEP?

PEP can be accessed through emergency rooms and the cost will be covered by OHIP if you are accessing PEP after experiencing sexual assault, accessing after occupational exposure (such as a needle-stick injury), or if you are under the age of 25 and are not covered by a private insurance.

For other high-risk exposures, the cost of PEP can be expensive. If you don’t have private drug insurance and are over the age of 25, a month’s supply of PEP can cost around $1,000. If you are unable to afford PEP, you can work with a health care provider and ask if they can help you find a way to access PEP at lower or no cost. It is important to note that across Ontario, access to PEP in emergency rooms can be inconsistent. PEP may not be readily available and the decision to prescribe PEP will be left to the discretion of the healthcare provider.

Tips for accessing PEP

For PEP to work, you need to start it as soon as possible, and not more than 72 hours after exposure. The sooner you can access it, the more effective it can be.
Not every emergency room has the same access to and experience prescribing PEP. Be as prepared as you can to advocate for yourself.
If you need support, bring someone you trust such as a friend or service provider with you.
It’s recommended that you get tested for HIV as soon as possible after a potential exposure (this is a baseline test to assess if there was HIV present before the potential exposure), at 3 weeks after the exposure, and at 6 weeks after the exposure. Ask your doctor about how to plan for follow up steps. Ontario Guidelines for Providers Offering HIV Testing (2023).
As PEP’s effectiveness is time sensitive, ask where you can get the medications immediately after leaving. If it is outside of pharmacy hours, you can ask if they provide a starter kit for taking the medications prior to picking up PEP from a pharmacy.

Download WHAI’s ‘PEP & Women: What You Need to Know’ pamphlet

PEP In Pocket (PIP)

PIP (PEP In Pocket) is the same medication as PEP but is prescribed BEFORE a potential exposure and is taken only AFTER there is a potential exposure.

PIP & Women: What You Need to Know

When might I want to get PIP?

PIP may be helpful for women who have infrequent potential HIV exposures and for those who face barriers to accessing PEP. This includes women who:

Had a condom break during sex
Had condomless sex with a partner whose HIV status is unknown
Infrequently share injection drug use equipment
Have trouble negotiating condom use for any reason
Have been sexually assaulted (and faces barriers to accessing free PEP through a sexual assault clinic)
May face barriers accessing timely emergency care

How do I access PIP?

PIP is a relatively new approach to HIV prevention in Ontario and there may be barriers to finding a health-care provider who will be familiar with PIP and is willing to prescribe it. There may also be barriers to accessing public or private health care insurance to cover the cost of the medication. In this case, contact your local ASO for support. ASOs can provide support when navigating HIV prevention tools such as PIP.

Read more in WHAI's PIP & Women: What You Need to Know.

Is there coverage for PIP?

The cost of PIP may be covered by private or public insurance (i.e., Ontario Drug Program). Because PIP is a newer approach to HIV prevention, it is important to work with your health-care provider or AIDS Service Organization (ASO) to explore options for coverage. You can also contact the following providers to inquire about navigating drug coverage:

Karla Fisher, Toronto General Hospital: karla.fisher@uhn.ca
Mia Biondi, Nurse Practitioner: mia.biondi@mail.mcgill.ca or 647-628-6461

In cases of sexual assault, PEP (Post Exposure Prophylaxis) is available for free through the Ontario Network of Sexual Assault Domestic Violence Treatment Centres; these programs vary throughout the province.

Why is PIP important for women?

Community Voices

Our work is always informed by the lived experiences of women.

Illustration of a green ivy plant with detailed leaves and a twisting vine on a white background.

Pink and yellow water lily in bloom against a dark background.

“I was on pre=exposure prophylaxis for a while but was only rarely having sex without a condom. I have an unexpected situation hapen probably only one or two times a year, when a doncom breaks or isn’t used. PIP seemed like a good choice for me because I don’t have to take a daily pill like with the pre-exposure prophylaxis and I can start the medication whenever I need to.”

- Woman’s Voice

Close-up of a purple petunia flower with a yellow center and water droplets on its petals.

“We need education for service providers about women and HIV. PrEP, PEP, PIP, U=U, testing. There is a lack of awareness, and it’s so important so women can find out more and so we can all work together.”

- Community Partner from Thunder Bay

Close-up of an orange lily flower with green leaves and buds in the background.

“I feel tremendous relief knowing that I can start my HIV prevention medications any time I choose. I once had to go to the hospital for postexposure prophylaxis. I remember having to wait a long time and then having an uncomfortable conversation with a doctor in a rather public setting about my exposure. PIP allows me to bypass the hospital and take ownership over my health.”