Written by Samantha Hyacinth with support from The Well Project
Approximately 1 in 7 of the estimated 1.1 million people living with HIV in the US are unaware of their diagnosis.¹ About 40% of new HIV cases involve transmission from someone who is unaware that they have it. Because it is important to start antiretroviral therapy as quickly as possible after the virus is contracted, the CDC recommends that primary care clinicians incorporate routine HIV screening into their care. Primary care visits can often be used as an opportunity to talk to patients broadly about their sexual and reproductive health needs whether that be preconception counseling, contraception, or STI screening.
The CDC recommends that everyone between ages 13-64 be screened for HIV at least once in their lifetime, and those at “high risk” for acquiring HIV should be screened at least annually.¹ We suggest offering an annual HIV test to anyone who is sexually active. Attempting to stratify patients based on “risk” puts them in a situation where they must decide whether your clinic environment is safe enough for them to divulge information that could lead to judgment from staff, such as same sex activity, unprotected intercourse, receiving money for sex, etc. The risk of acquiring HIV is not limited to any of the populations considered “high risk.” Rather than using additional clinical time to ask patients a series of questions that could result in their feeling and/or being judged, we can shift to a model where we ask patients three simple questions: whether they are sexually active, the timing of their last HIV test, and whether they (or, to their knowledge their partners) have had any new sexual partners.
In addition to universal screening, another way to reduce HIV transmission is by increasing the availability of Pre-exposure Prophylaxis (PrEP). The CDC recommends that clinicians tell all sexually active patients about PrEP to increase patient knowledge and access. PrEP is especially useful for people who are HIV negative who have a partner living with HIV. There are three FDA approved options for PrEP:
- Emtricitabine 200 mg in combination with tenofovir disoproxil fumarate 300 mg (Truvada®) oral tablet taken daily.
- Patients should have a creatinine clearance of ≥60 mL/minute using the Cockcroft-Gault formula
- Emtricitabine 200 mg in combination with tenofovir alafenamide 25 mg (Descovy®) oral tablet taken daily.
- Not recommended for preventing HIV acquisition in people assigned female at birth who have vaginal intercourse due to lack of efficacy data
- Patients should have a creatinine clearance of ≥30 mL/minute using the Cockcroft-Gault formula
- Cabotegravir 600 mg (Apretude®) injection given every 2 months.
Along with routine screening for HIV and PrEP, it’s important that we inform patients who have a partner living with HIV that if their partner’s viral load is undetectable, HIV is untransmittable.
The Well Project Resources:
3. Centers for Disease Control and Prevention: US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 Update: a clinical practice guideline. https://www.cdc.gov/hiv/pdf/
For the months of June, July, and August, RHAP will be working alongside The Well Project to create a summer “string of pearls” series on HIV care and preconception, contraception, and screening.
The Well Project is a non-profit organization whose mission is to change the course of the HIV/AIDS pandemic through a unique and comprehensive focus on cis and trans women and girls. The Well Project envisions a world in which women living with or vulnerable to HIV have the information, support, and tools they need to advocate for their health and well-being, and live free from stigma.
Founded in 2002, The Well Project has become a recognized leader in the fight against HIV by revolutionizing the availability and accessibility of much-needed resources designed specifically for women living with and vulnerable to HIV and by prioritizing the advancement of women in all aspects of HIV prevention, treatment, and cure research and policy.
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.