D.C. PrEP for Women Initiative
The D.C. PrEP for Women initiative is a public-private partnership between the Washington AIDS Partnership and the D.C. Department of Health’s HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA). It aims to increase knowledge and use of Pre-Exposure Prophylaxis (PrEP) among women of color in Washington, D.C. PrEP allows individuals at high risk for HIV infection to take HIV medication regularly to lower their chances of getting infected. With generous support from the MAC AIDS Fund, the D.C. PrEP for Women initiative is one of the first city-wide programs in the country to focus specifically on PrEP for women of color.
Goals for the initiative include:
- Leverage HIV and women’s health providers to adopt and offer PrEP as an effective strategy to reduce HIV infection;
- Educate women at high risk for HIV to normalize and increase interest in PrEP;
- Change and expand the conversation about PrEP and women from “protecting her from him” to “taking care of yourself;” and
- Increase the knowledge and number of health providers prescribing PrEP for women.
Why PrEP for Women?
At least 2% of Washington, D.C. residents (13,391) are living with HIV, surpassing the WHO’s 1% threshold for a generalized epidemic [i] The lifetime risk for HIV diagnosis, the likelihood a person will be diagnosed with HIV during their lifetime, is 1 in 13 for D.C., the highest in the U.S.[ii] Furthermore, one in six new diagnoses in the District is an African American woman, the second highest proportion of all new cases.[iii]
PrEP has tremendous potential to reduce the infection risk among women in D.C. When taken consistently, PrEP has been shown to reduce the risk of HIV infection among individuals at high risk by up to 92%.[iv] However, there is a significant PrEP awareness gap among women of color. In a recent focus group conducted for HAHSTA, the participants’ initial reaction was anger that there had not been prior communication to them about PrEP. Women who took part in a six city focus group study had the same reaction, with almost none of the participants having heard of PrEP before.[v] In another set of focus groups conducted by the Women’s Interagency Health Study, HIV-negative D.C. women expressed enthusiasm about PrEP, and wanted to use and recommend it to others.[vi] Locally and nationally, focus group participants were highly interested in PrEP as a woman-controlled prevention strategy, as long as barriers such as cost, efficacy knowledge, distrust of the medical system, and stigma (including unwillingness to discuss PrEP with provider) were addressed.[vii]
In January 2017, the Washington AIDS Partnership funded three innovative PrEP for Women projects: Children’s Research Institute, Mary’s Center for Maternal and Child Care, and Planned Parenthood of Metropolitan Washington. These organizations were funded to integrate PrEP into existing clinical services and to educate patients and health provider staff about PrEP as an option to reduce HIV risk. Additionally, Children’s Research Institute will support PrEP capacity building by training outside health care providers who serve adolescents at high risk for HIV.
The selection of three organizations that provide medical services is an exciting direction for the initiative. The Washington AIDS Partnership chose to focus grantmaking on increasing the PrEP capacity of health care organizations as this is a key component to increase PrEP uptake. Grant funds will be used to address multiple aspects of PrEP uptake by creating an environment for women to learn about PrEP from a trusted source, creating protocols to support a seamless patient transition from receiving education to receiving PrEP services, and equipping providers to discuss PrEP with patients and prescribe it.
Children’s Research Institute
Children’s Research Institute (CRI) is the academic arm of the Children’s National Health System (CNHS), an internationally recognized provider of pediatric services in the Greater Washington region. CRI operates a successful pediatric emergency department (ED) HIV point-of-care testing and STI screening program at United Medical Center (UMC), located in ward 8. PrEP for Women funding will support the integration of PrEP into the UMC ED HIV/STI screening program. CRI will develop youth- and female-friendly PrEP educational materials. Additionally, HIV-negative female patients who test positive for an STI through the screening program (which indicates increased risk for HIV) will be provided with more intensive follow-up, including PrEP education. The funding will also support PrEP training and education for CNHS UMC ED providers and PrEP capacity building among pediatric and adolescent health care providers in the Greater Washington region.
Mary’s Center for Maternal and Child Care
Mary’s Center for Maternal and Child Care is a Federally Qualified Health Center providing medical, education, and social services for patients at three sites across Washington, D.C. and Maryland. Part of Mary’s Center’s mission is to embrace culturally diverse communities to provide them with the highest quality of care, regardless of ability to pay. PrEP for Women funding will support integration of PrEP into Mary’s Center’s existing services. The project plan includes hiring a full time PrEP coordinator nurse, training internal staff on PrEP, and integrating PrEP into existing educational activities.
Planned Parenthood of Metropolitan Washington
Planned Parenthood of Metropolitan Washington (PPMW) provides quality affordable health care and education for women, men, and teens in the Greater Washington region. PrEP for Women funding will help PPMW expand its reproductive health and educational services to include PrEP. Integrating PrEP into a family planning setting is a promising strategy as women’s health providers already have extensive experience with and regular access to their female patients. Funds will support activities such as developing and implementing evidence-based internal PrEP protocols, training staff on PrEP integration in the family planning setting, and integrating PrEP into existing educational outreach activities, both in-person and online.
Year 2 Grantmaking
The Washington AIDS Partnership will conduct a second round of PrEP for Women grantmaking in fall 2017. Information on year two grantmaking will be available in late summer 2017.
PrEP and the District of Columbia’s Plan to End HIV
Increased use of PrEP is a key strategy in the 90/90/90/50 Plan to End HIV in the District of Columbia. This plan is a collaboration between D.C. Mayor Muriel Bowser, DC Appleseed Center, D.C. Department of Health, and the Washington AIDS Partnership. The four goals of this plan are:
- 90% of HIV-positive District residents know their status
- 90% of District residents diagnosed with HIV are in treatment
- 90% of District residents diagnosed with HIV who are in treatment reach viral load suppression; and,
- 50% reduction in new infections, all by the year 2020
In Task 4.1, the D.C. Department of Health commits to expanding the network of providers of PrEP through increased knowledge and capacity of private medical providers. The PrEP for Women initiative is highlighted as a demonstration project for increasing PrEP uptake. For more information about the plan, visit this page on our website.
For more information on PrEP, please visit www.prepforher.com.
[i] DC Annual Epidemiology & Surveillance Report: 8. Released 2016.
[ii] Centers for Disease Control and Prevention 2016 Lifetime HIV Risk Diagnosis Factsheet. http://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html. February 2016.
[iii] DC Interim HIV/AIDS Surveillance Report – Preliminary 2014 Data. Released 2016
[iv] Centers for Disease Control and Prevention Pre-Exposure Prophylaxis (PrEP). http://www.cdc.gov/hiv/risk/prep/ July 2016.
[v] Knowledge, Attitudes, and Likelihood of PrEP Use. Auerbach et al. AIDS Patient Care STDS. 2015 Feb;29(2):102-10.
[vi] Women want Pre-Exposure Prophylaxis but are Advised Against it by Their HIV-positive Counterparts. Goparaju et al. J AIDS Clin Res. 2015; 6:521
[vii] Knowledge, Attitudes, and Likelihood of PrEP Use. Auerbach et al. AIDS Patient Care STDS. 2015 Feb;29(2):102-10.