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School and Program Updates

Yale: Federal Guidelines May Inadvertently Restrict Women’s Access to Effective HIV Protection

Restrictive recommendations for pre-exposure prophylaxis (or PrEP) issued by the Centers for Disease Control and Prevention (CDC) systematically disqualified nearly all women at risk for human immunodeficiency virus (HIV) and/or motivated to use the medication, researchers at the Yale School of Public Health and George Washington University have found.

The study, published in the Journal of Acquired Immune Deficiency Syndromes found that many state public health departments appear to model their pre-exposure prophylaxis (PrEP) guidelines after federal guidelines, reinforcing the impact of the problematic recommendations on clinical practices throughout the country. Research suggests that, if taken as prescribed, PrEP is close to 100 percent protective against the sexual transmission of HIV.  Women account for less than 5 percent of PrEP users even though they represent 19 percent of new HIV diagnoses. According to the researchers, clinical practice standards could be partly to blame.
Researcher Dr. Sarah K. Calabrese found that CDC criteria disqualified 98.5 percent of the women. Moreover, they disqualified 96.2 percent of women reporting one or more recent sexually transmitted infections (STIs),  97.0 percent of women with multiple sexual partners, 97.2 percent of women who expressed the desire to use PrEP, and 100 percent of women who perceived themselves to be at high risk for HIV.
According to the researchers, a key reason that women do not meet recommended indications is because the criteria require them to be aware of their partner’s HIV risk or recognize a potentially asymptomatic sexually transmitted infection (STI). They deemed these criteria to be unrealistic and point out that men who have sex with men can qualify for PrEP based on their own sexual risk behavior alone, without needing to know about partner risk.
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