Family planning providers can help address racial and gender disparities in HIV prevention

Pre-exposure prophylaxis (PrEP) is highly effective and offers the first woman-controlled method of HIV prevention that can be taken in advance of exposure. Despite these benefits, only a small portion of eligible women have ever been prescribed it. Black and Latina women are far more likely to acquire HIV than white women, but disproportionately fewer women of color have been prescribed PrEP. There is an urgent need to reach more women, and new commentary from UCSF & University of Missouri makes the case that family planning clinics have an important role to play in filling the gap.

Offering PrEP services is a natural fit for family planning providers. Studies show that women view them as “trusted providers” and expect to receive HIV prevention information at family planning visits. Family planning clinics may be the only way to reach some women—40% of women in the US only access reproductive healthcare. As family planning clinics serve a racially and ethnically diverse population and are often the only places uninsured immigrant women may access services, they can play in a role in addressing racial disparities in PrEP access.

There are lessons learned in family planning that apply directly to PrEP implementation, like similarities between oral PrEP and oral contraceptives and similar individual, community and structural determinants of health affecting family planning and HIV. However, there are also significant challenges. It’s difficult to address multiple health priorities in a single clinic visit and providers and staff require new training.

Early adopters offering PrEP services offer some guidance for other family planning clinics:

  • Identify a clinic champion who can motivate others and lead by example.
  • Don’t reinvent the wheel; use existing PrEP materials and training resources.
  • Provide post-exposure prophylaxis (PEP) as another opportunity to expand HIV prevention services and discuss with patients to see if daily medication is a viable option for them.
  • Bundle PEP and PrEP with preexisting clinical care to streamline follow-up.
  • Develop and call on allies in the HIV community who are eager to support PrEP rollout through training, consultations and partnerships.
  • If a new HIV diagnosis is made, explore opportunities for improvement and look back to see if clinic staff talked to the patient about PrEP.
  • Be prepared to welcome new clients; offering PrEP often attracts more cisgender men and transgender people, providing an opportunity to provide sexual and reproductive health services to clients across the gender spectrum.

While adding more services may seem overwhelming to overstretched clinics, playing a role in PrEP implementation doesn’t necessarily mean offering PrEP services on day one. Clinics can start by offering information and identifying PrEP providers in the community. Integrating PrEP in family planning clinics is not only possible, it’s critical. The consequences of inaction are profound and may result in increasing disparities as women of color carry the burden.

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