HIV Prevention

HIV prevention has the power to eliminate HIV. In order for prevention to work, strategies must take into account women's life circumstances.

Prevention

Currently, the main methods of protection against HIV transmission are:

Condoms and other physical barriers when engaging in sexual activity
Using sterile and single use needles and other drug injection equipment (i.e. not sharing equipment with others)
HIV treatment to reduce the viral load of people living with HIV
Pre-exposure prophylaxis and post exposure prophylaxis (PrEP and PEP)

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.

Condoms and Other Physical Barriers

How they work and different options

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.

What are the options?

External Condoms (sometimes referred to as a "male condom"). External condoms are typically made of latex but polyurethane options are also available. These are to be worn on the penis* during sex.

Internal Condoms (sometimes referred to as a "female condom"). Insertive condoms are always made from polyurethane, can be inserted into the vagina or anus up to 8 hours in advance, and may be a good option for people whose partners will not (or cannot) use external and/or latex condoms; however, they are more expensive and less available than external condoms.

Dental dams are a square piece of latex that can be used as a barrier for vaginal*, or anal oral sex. It is important to note that the risk of HIV transmission through oral sex is negligible.

Flavoured condoms or non-lubricated condoms can be used for oral sex on a penis.**

Click here for more information on preventing HIV and STI transmission through condom use.

* Trans communities may refer to their genitals using different language. For more information about language and safer sex with Trans women, see Brazen: Trans Women’s Safer Sex Guide. For more information about language and safer sex with Trans men, see Primed²: A Sex Guide for Trans Men into Men

HIV Treatment and Viral Load Suppression

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 2015, approximately 80% of people living with diagnosed HIV in Ontario were virally suppressed.

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

To learn more about U=U and Women, click here.

Viral load testing is part of routine checkups for people living with HIV who are engaged in care and on treatment. Accessing and staying engaged in care has shown improved health outcomes for people living with HIV, and is a very effective prevention tool.

To learn more about suppressing viral load as a prevention method, click here.

Pre-Exposure Prophylaxis (PrEP)

What is 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. To learn more about PrEP, check out Ontario PrEP.

Does it work?

Across numerous studies and reports, PrEP has proven to be over 90% effective at preventing the transmission of HIV when taken as directed. PrEP needs to be taken for a minimum of 20 days to protect against HIV transmission in vaginal tissue and 7 days in rectal tissue. This means it takes longer to be effective for vaginal sex than anal sex.

While there is still limited research about PrEP’s effectiveness among Trans women, existing research regarding tenofovir and emtricitabine (which PrEP consists of) indicates that it is highly effective at preventing HIV acquisition among Trans women and people on hormone replacement therapy when taken as directed. PrEP is also safe to take for people who are pregnant, people who are breast/chestfeeding, people who use any form of birth control, as well as recreational or street drugs.

Why is PrEP important for women?

There are numerous potential advantages of PrEP. For example, PrEP may provide another method of protection for:
Women who are unable to negotiate condom use with their partner(s);
Women in relationships with an HIV-positive partner(s);
Women who wish to conceive a child through sex with an HIV-positive partner;
Women who inject drugs but are not able to obtain new needles;
Women who have difficulty using condoms consistently for any reason.

Is PrEP accessible?

As of September 28, 2017 the Ontario Drug Benefit (ODB) program approved 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. As of April 1, 2019, the ODB will also cover drug costs for those between 18 and 24 years of age 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.

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

Click here to learn more about PrEP, including information about microbicides and other new forms of PrEP in development.

Post-Exposure Prophylaxis (PEP)

What is PEP?

PEP refers to a prescribed medication that prevents HIV acquisition for anyone who may have recently been exposed to HIV infection. As PEP is not 100% effective, starting earlier can increase its effectiveness. It can be prescribed up to 72 hours after exposure and the sooner it is accessed the more effective it can be.

How can you get 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 emergency room staff 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.

When might women want to get PEP?

Tips for Accessing PEP

Not every emergency room has the same access to and experience prescribing PEP. Be 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.
Be prepared to discuss the details of your exposure. This can be very difficult to do but the more honest and detailed you can be, the more the intake healthcare provider can understand what happened and get you the care you need.
It’s recommended that you get tested for HIV 3 weeks, 6 weeks, and 3 months after exposure. Ask your doctor about how to plan for follow up steps.
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.

CENTRING WOMEN'S EXPERIENCES

"We must avoid creating two classes of people with HIV; those who have an undetectable viral load and those who do not."

— Ontario AIDS Network

RESOURCES

Brochure, WHAI Resource

WHAT CAN WE HELP YOU FIND?

HIV Prevention

HIV prevention has the power to eliminate HIV. In order for prevention to work, strategies must take into account women's life circumstances.

Prevention

Condoms and Other Physical Barriers

How they work and different options

What are the options?

HIV Treatment and Viral Load Suppression

Undetectable = Untransmittable*

Pre-Exposure Prophylaxis (PrEP)

What is PrEP?

Post-Exposure Prophylaxis (PEP)

What is PEP?

CENTRING WOMEN'S EXPERIENCES

RESOURCES

PEP & Women (2019)

Living in the Asterisk(*)

Brazen

Fact Sheet: HIV Treatment and an Undetectable Viral Load to Prevent HIV Transmission

PrEP & Women (2019)

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