“Why aren’t more women on PrEP?”

This is getting extremely disturbing

Just today, the day after World AIDS Day, the following article appeared in the UK Huffington Post:

PrEP Can Prevent HIV Infections, But Most Women Don't Know They Can Take It

Already, even the title of the piece is condescending, implying that “most women” are ignorant of “medical advances.” But perhaps the reason “most women” don’t know about PrEP is because up until very recently, PrEP was not marketed to “most women.” Indeed, it’s only in the last few months that there has been a concerted push to make PrEP “mainstream,” branching out from the prevailing attitude of the last nearly four decades, which is that “HIV drugs” are only for members of “risk groups.” It’s very strange, and I have some ideas as to why this is happening.

Let’s dive into the article.

When it comes to lowering your risk of getting infected with HIV, there is one immensely valuable yet grossly underused medication that doctors recommend.

[…]

PrEP is an important HIV infection prevention tool that many folks either don’t know about or don’t think they’re eligible for. It’s estimated that only “about 30% of the people who should be on PrEP are on PrEP and of them in the U.S., only 7% of PrEP users are women,” Shankaran said.

There’s a dangerous myth that women can’t take PrEP, which is probably why use among this demographic is so low. But with 18% of new HIV diagnoses in the U.S. happening in women, prevention is necessary.

How is it determined who “needs to be” on PrEP? And I didn’t know that there was a “dangerous myth” that women can’t take PrEP. This is a new one on me. I also like the statistic they mention, that 18% of “new HIV diagnoses” in the US are among women as though that hasn’t always been the case, to within a margin of error.

I’ve noticed recently a trend away from stating a numerical efficacy rate for PrEP, so I’m curious if this piece mentions one (emphasis mine).

The Centers for Disease Control states that PrEP lowers your risk of contracting HIV sexually by 99% and 74% when it comes to HIV contraction via injection drug use.

“The different studies had varying levels of protection, but most of those were related to how well someone adhered to taking the pills,” Shankaran explained. “So if you took the pills most of the time, if not all of the time, it’s very, very effective — obviously, if you don’t take it, it’s not going to be effective.”

I see they quote the CDC, which is interesting because the studies referenced on the CDC website exhibit a wide range of efficacy, but not 99%. Ever. One of the biggest PrEP studies, the iPreX study, came up with an effectiveness of 43%, with roughly half as many “seroconversions” in the PrEP group as in the placebo group. As I have mentioned before, these artificially high estimates are derived from extrapolations based on drug concentrations in dried blood spots in PrEP users who self-report varying levels of adherence, assuming a strong correlation between adherence and effectiveness, but the problem is that this is not reflected in reality, nor in the clinical trials used to derive those figures. I’ll be addressing this in a detailed post very soon. Moving on.

There are currently three options for PrEP in the U.S.; two of the treatments are pills and one is an injectable. Cisgender women are eligible for two of the three treatments, according to Shankaran: Truvada, a pill treatment, and Apretude, which is the injectable medication.

I’m so happy to know that “cisgender women” are eligible for Truvada. That shouldn’t cause any issues whatsoever.

“The CDC currently recommends that if you’re a cis woman, you take the medication, the Truvada, for example, if it is a pill, you take it every day, and about after about 21 days or so you’re fully protected,” Shankaran said.

For Apretude, the injectable medication, the time it takes for someone to be fully protected is unknown, according to the CDC. This is because the medication has been available for a shorter time, Shankaran said.

“The time it takes for someone to be fully protected is unknown.” How reassuring. For forty years, there’s been this attitude from the AIDS establishment that “the science” is just sooooo complex and difficult to understand (even by researchers apparently — remember, “We’re still confused [as to how HIV kills T cells] but at least we’re confused at a higher level of understanding”?) that any anomalies or failed predictions have nothing to do with the fact that HIV AIDS has long since been falsified, but are instead the result of “HIV” being “wily” and “intelligent,” an interesting anthropomorphization of a relatively small, nine-gene retrovirus. Anyone asking obvious questions, if not called a “denialist,” is dismissed as just unable to comprehend “the science” surrounding “HIV.” How ridiculous, and once again, condescending.

PrEP is just one part of a full strategy for people to stay HIV-free.

“The reason I say it’s a strategy because I think the medication, whether it be a pill, or injectable, is sort of just part of it — so, it’s either a pill a day that people can take, or an injectable medication every two months,” said Dr. Oni Blackstock, the founder and executive director of Health Justice, an organisation that works with health care groups to reduce health inequities and centre anti-racism.

But, beyond the pill or injectable, there are additional levels of care someone receives when they start PrEP.

“They’re going to be seeing a provider every few months, they’re going to be tested for sexually transmitted infections that can co-occur with HIV, they’ll be checked for how they’re tolerating the medication, they’ll be counselled on any sort of sexual or drug use behaviours that may be associated with HIV,” Blackstock said.

“So, I just think of it as sort of a bundle of care to help people who are HIV-negative stay HIV-negative,” she added.

What is with this insane push to have everyone, including teenagers and senior citizens, “retained in care” on PrEP? Did the fact that billions of people eagerly lined up to take the barely tested COVID vaccines, when they didn’t even need them (and they turned out to, well, not work very well) embolden the public health authorities to try and sell everything to everyone?

I’m getting tired already, and we’re not done yet. The conclusion of the article includes some hand-wringing about how “cisgender women,” especially Black cisgender women, are misinformed and underutilizing PrEP.

Through no fault of their own, many cisgender women do not know that PrEP is a medication they can use to reduce their risk of contracting HIV.

“Because PrEP has been historically heavily marketed to men who have sex with men ... it really gave the impression that PrEP was not something that ... cisgender women could take, and unfortunately, this is sort of reinforced by many health care providers.” Blackstock said, “I’ve heard stories of women saying, ‘Well, my doctor said this is something only gay men take or that I can’t take it if I’m pregnant or if I’m breastfeeding or if I’m trying to get pregnant.’”

The misinformation combined with the lack of marketing toward cisgender women has led to a low uptake of PrEP among this group, Blackstock said. Black women, who account for half of new HIV infections in women, are on PrEP even less.

I’ve said it before, and I’ll say it again, but the Black community is right to be suspicious of aggressive “public health” schemes aimed directly at them, given the history, which includes, among other atrocities, the Tuskegee syphilis experiment.

Finally, we conclude with the “empowerment” message (emphasis mine):

“The really wonderful thing about PrEP is that it’s user-controlled, a woman can take it with or without her partner’s awareness and knowledge — some women may be in a situation where it may not be safe to share with their partner that they’re taking PrEP, but it allows a woman to protect herself,” Blackstock noted.

And just to underscore this point: PrEP is for people of all gender identities and sexual orientations and is an immensely valuable way to stay HIV-free.

That last sentence says it all. PrEP is for everyone now. Maybe since a vaccine against “HIV” is unlikely to eventuate, we’ll eventually (or maybe at warp speed) get to injectables every six months; a kind of “anti-HIV booster,” if you will, offered along with your flu shot. A year ago, I’d have thought this would never happen, but I’m reconsidering that notion.

What do you think? What is behind this push to market PrEP so widely? Is it merely profit-based (even if the government pays for it and not the patient, the pharmaceutical companies get paid regardless—they’re not doing this for free), or is something more sinister going on?

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