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Integrating Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention Into Women's Health Care in the United States

Seidman, Dominika MD; Weber, Shannon MSW

doi: 10.1097/AOG.0000000000001455
Contents: Current Commentary
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Women comprise one in five new human immunodeficiency virus (HIV) diagnoses in the United States. Trials and implementation projects demonstrate preexposure prophylaxis for HIV prevention is effective in women. Preexposure prophylaxis is a method of preventing HIV acquisition by having an HIV-negative individual take antiretroviral medication before exposure. The U.S. Food and Drug Administration approved daily oral tenofovir disoproxil fumarate coformulated with emtricitabine as preexposure prophylaxis for HIV prevention in 2012. Preexposure prophylaxis is highly dependent on adherence for effectiveness. The Centers for Disease Control and Prevention recommends offering preexposure prophylaxis to individuals at significant risk of infection and estimates 468,000 women in the United States are eligible for preexposure prophylaxis. Although variable individual and structural forces affect each woman's medication adherence, and therefore the effectiveness of preexposure prophylaxis, women's health care providers are uniquely positioned to screen, counsel about, and offer preexposure prophylaxis. Shared decision-making provides a framework for these clinical encounters, allowing patients and clinicians to make health care decisions together based on scientific evidence and patient experiences. By incorporating fertility desires and contraceptive needs, health care providers effectively integrate sexual and reproductive health care. Including preexposure prophylaxis in women's health services requires health care provider training and attention to lessons learned from family planning and HIV prevention. Nevertheless, obstetrician–gynecologists have an opportunity to play a critical role in reducing sexual transmission of HIV in the United States by integrating preexposure prophylaxis education and provision into their practices.

Obstetrician–gynecologists may play a critical role in reducing sexual transmission of human immunodeficiency virus by integrating comprehensive prevention services into their practices.

Department of Obstetrics, Gynecology and Reproductive Sciences, and HIVE, San Francisco General Hospital, University of California San Francisco, San Francisco, California.

Corresponding author: Dominika Seidman, MD, San Francisco General Hospital, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110; e-mail: Dominika.seidman@ucsf.edu.

Financial Disclosure The authors do not report any potential conflicts of interest.

The authors thank Stephanie Cohen, Christine Dehlendorf, Judy Levison, and Hilary Seligman for their thoughtful comments.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.